Tax Intake

CLIENT FORM
How did you hear about us?

FacebookInstagramReferralPrevious Client
How would you like to finish the prparation of your tax retun?

Remotely Via EmailIn OfficeOther
Preferred Tax Preparer Name, If Any
If someone referred you, please type his or her name here.
How would you like to receive your tax refund and or Refund Advance?

Check (Only available for in office visits)Direct DepositPrepaid CardRefund Advance $500-$7,000
What tax year are you submitting today? (Please look at your tax documents and select the correct year)

20242023202220212020Other
Did you trade any Virtual Currency

YesNo
Are you interested in AUDIT PROTECTION?

YesNo
Taxpayer Information
Taxpayer's Name*

First NameLast Name
Taxpayer's Phone Number*
Example: xxx-xxx-xxxx
Taxpayer's Work Phone Number*
Example: xxx-xxx-xxxx
Taxpayer's Job Title*
Taxpayer's Date of Birth*
Example: 01/01/2001
Taxpayer's SSN*
Example: xxx-xx-xxxx
Does The Taxpayer Have an IP PIN (Identity Protection PIN)
This is a six-digit number assign to you by the IRS
Taxpayer's Email Address*
example@example.com
Gender*

MaleFemale
Dependent on another?*

YesNo
Legally Blind?*

YesNo
Disabled?*

YesNo
Text Message?*

YesNo
Taxpayer's Cell Phone Carrier*
Example: At&t, C-spire, ect
Is Taxpayer Self Employed?*

YesNo
Upload Taxpayer's State Issued Picture ID.*

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Upload Taxpayer's Social Security Card.

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Spouse Information
Did you and your spouse live apart during the year?*

YesNoNot Applicable
Spouse's Name

First NameLast Name
Does The Spouse Have an IP PIN (Identity Protection PIN)
This is a six-digit number assign to you by the IRS
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Work Phone Number
Example: xxx-xxx-xxxx
Spouse's Job Title
Spouse's Date of Birth
Example: 01/01/2001
Spouse's SSN
Example: xxx-xx-xxxx
Spouse's Email Address
example@example.com
Gender

MaleFemale
Dependent on another?

YesNo
Legally Blind?

YesNo
Disabled?

YesNo
Text Message?

YesNo
Spouse's Cell Phone Carrier
Example: At&t, C-spire, ect
Is Spouse Self Employed?

YesNo
Upload Spouse's State Issued Picture ID.

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Upload Spouse's Social Security Card.

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Address Information
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Principal home or dwelling for more than half of the year?

YesNo
Filing Status
What is your marital status as of December*

Single (Not Married on or before December 31, 2024 and/ or Your Dependents lived with you for less than 6 months during the year)Married Filing Jointly (You were married as of December 31, 2024 or your spouse died during 2024.)Married Filing Separate (Married on or before December 31, 2024 and your spouse is filing a tax return using this filing status.)Head of Household (If you were NOT married as of December 31, 2024 and your child, foster child, or grandchild lived with you for more than 6 monthsWidowed with a Dependent ( Your spouse died during either 2022 or 2024, and Your child, stepchild or foster child lived with you for 12 months in 2023.)
Did you pay over half the expenses of maintaining your residence for the entire year?*

YesNo
Did you support a child or family member for more than 6 months out of the year?*

YesNo
Bank Information

(for Direct Deposit into Taxpayers Personal Acct.)
Name of Bank
Which type of account would you like your refund deposited into?

Checking AccountSavings AccountOther
Routing Number
Bank Account Number
Health Insurance

(Affordable Care Act)
In order to comply with the Affordable Care Act, answer the following questions regarding healthcare insurance coverage.
Received health care coverage through employer for the entire year (including COBRA Coverage)?*

YesNoN/A
Received health care coverage from the government such as Medicaid, Medicare or Veterans Benefits?*

YesNoN/A
Purchased private health insurance (NOT through the Marketplace) for the entire year?*

YesNoN/A
Purchased health insurance through the "Marketplace" (Form 1095-A)?*

YesNoN/A
At least one family member (including taxpayer) did not have health care coverage at anytime during the year?*

YesNoN/A
Upload Taxpayer & Dependent(s)Insurance Documents

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Dependents
Have you ever been denied the Earned Tax Credit (EITC)?

YesNo
How many dependents are you claiming?*
Dependent #1

First NameLast Name
Dependent #1 Date of Birth
01/01/2001
Dependent #1 SSN
What is Dependent #1's Relationship to you (son, daughter, etc.)?
How many months did Dependent #1 live with you in 2024? (If all year, enter 12)
Upload Dependent #1 Social Security Card.

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Upload Dependent #1 Birth Certificate.

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Dependent #2

First NameLast Name
Dependent #2 Date of Birth
Example: 01/01/2001
Dependent #2 SSN
How many months did Dependent #2 live with you in 2024? (If all year, enter 12)
What is Dependent #2's Relationship to you (son, daughter, etc.)?
Upload Dependent #2 Social Security Card.

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Upload Dependent #2 Birth Certificate.

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Dependent #3

First NameLast Name
Dependent #3's Date of Birth
01/01/2001
How many months did Dependent #3 live with you in 2024? (If all year, enter 12)
Dependent's #3 SSN
What is Dependent #3's Relationship to you (son, daughter, etc.)?
Upload Dependent #3 Social Security Card.

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Upload Dependent #3 Birth Certificate.

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Dependent #4's First Name
First Name
Dependent #4's Last Name
Last Name
Dependent #4's Date of Birth
01/01/2001
Dependent #4's SSN
Example: xxx-xx-xxxx
What is Dependent #4's Relationship to you (son, daughter, etc.)?
How many months did Dependent #4 live with you in 2024? (If all year, enter 12)
Upload Dependent #4 Social Security Card.

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Upload Dependent #4 Birth Certificate.

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Dependent #5's First Name
First Name
Dependent #5's Last Name
Last Name
Dependent #5's Date of Birth
01/01/2001
Dependent #5's SSN
Example: xxx-xx-xxxx
What is Dependent #5's Relationship to you (son, daughter, etc.)?
How many months did Dependent #5 live with you in 2024? (If all year, enter 12)
Upload Dependent #5 Social Security Card.

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Upload Dependent #5 Birth Certificate.

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Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.

YesNo
Dependent Care Expenses

Daycare / After School Care
Provider's Name / Business or Individual
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Provider Tax ID or SSN
Total Paid In 2024
Upload a copy of your daycare form here.

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Wages and Salaries
Did You Receive Unemploment Benefits in 2024?

YesNo
If Yes, Upload Taxpayer and/or Spouse Documents

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Are you receiving any Government Assistance*

YesNoNot Applicable
How many W-2's Does the Taxpayer Have For 2024?*
Taxpayer's W-2 #1 Please Upload

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Taxpayer's W-2 #2 Please Upload

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Taxpayer's W-2 #3 Please Upload

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Taxpayer's W-2 #4 Please Upload

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Taxpayer's W-2 #5 Please Upload

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How many W-2's Does the Spouse Have For 2024?*
Spouse's W-2 #1 Please Upload

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Spouse's W-2 #2 Please Upload

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Spouse's W-2 #3 Please Upload

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Taxpayer's W-2 #4 Please Upload

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Spouse's W-2 #5 Please Upload

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Do you have any Interest and/ or Dividend Income in 2024?

YesNo
Please Upload

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Please Upload

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Do you have any additional income in 2024? (SSA1099, Alimony, Gambling Income, IRA, Pension, Railroad Retirement RPB1099, etc)

YesNo
Please Upload

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Please Upload

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Credits
Were you or any of your dependents in college in 2024?

YesNo
Do you have a 1098-T Form for either you or your dependents?

YesNo
If you have a 1098-T form, upload it here.

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Itemized Expenses
Do you have any Medical and Dental Expenses?

YesNo
Type a question
Do you have any Taxes Paid?

YesNo
If yes, please enter the total.
Do you have any Interest Paid?

YesNo
If yes, please enter the total.
Do you have any Gifts to Charity?

YesNo
If yes, please enter the total.
Do you have any Other Miscellaneous Deductions?

YesNo
If yes, please enter the total.
Do you have any Other Expenses?

YesNo
If yes, please enter the total.
Signatures and Additional Documents Uploads
CLIENT NON PAYMENT/OFFSET CLAUSE

At Thames Tax Solutions, we strive to assist all of our clients in their tax needs, howwever we understand that situations arise. If your refund is offset by the IRS, student loans, child support or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return.

By signing this agreement you acknowledge that if payment is not made in full with in 30 days legal actions will be sought to resolve payment.
Primary Taxpayer's Signature

Clear
ADDITIONAL SERVICES

At Thames Tax Solutions, we do more than just taxes. Please check below if you would be interested in any of the additional services we provide. We will schedule a time to speak with you ar a later time.
Additional Services

BookkeepingPayroll ServiceLLC/ Small Business Formation501c3 Status Setup
I am giving Thames Tax Solutions permission to prepare all forms related to my tax return; to apply for and secure Refund Advance on my behalf; and sign all necessary forms and file my taxes electronically. I take full responsibility for the accuracy of this form and understand that Thames Tax Solutions and/or associated affiliates hold no responsibility for any misrepresentation or false claims.
Date

MonthDayYear
Date
Taxpayer's Signature (If no spouse, leave blank)

Clear
Spouse's Signature (If no spouse, leave blank)

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Date

MonthDayYear
Date
Taxpayer's Driver's License

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Taxpayer's and Dependent(s ) Social Security Card(s)

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Taxpayer's W-2/ 1099'S

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Dependent(s) Birth Certificate(s)

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Dependent(s) Proof of Residency (Lease/Utility Bill)

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Please Upload All Additional Tax Documents

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Should be Empty:

CLIENT FORM

Taxpayer Information

Spouse Information

Address Information

Filing Status

Bank Information

Health Insurance

Dependents

Dependent Care Expenses

Wages and Salaries

Credits

Itemized Expenses

Signatures and Additional Documents Uploads