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 EmailRemotely Via ZoomIn OfficeOther
Tax Preparer Name
If someone referred you, please type his or her name here.
Email
example@example.com
Tax Payers Name

First NameLast Name
Taxpayer's 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
Taxpayer's Email Address*
Upload Taxpayer's State Issued Picture ID.

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Upload Taxpayer's Social Security Card.

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Spouse's Full Name
First Name
Spouse's SSN
Example: xxx-xx-xxxx
Name

First NameLast Name
Spouse's Date of Birth
Example: 01/01/2001
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Email Address
Example: example@example.com
Taxpayer's SSN
Example: xxx-xx-xxxx
Spouse's Job Title
Upload Spouse's State Issued Picture ID.

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Upload Spouse's Social Security Card.

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Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you self employed?*

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

YesNoNot Applicable
What is your marital status as of December*

Single (Not Married)Married living with SpouseMarried not living with spouseWidowed with a Dependent
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
If yes, did you live together at any time after June 30, 2023?*

YesNoNot Applicable
Are you receiving any Government Assistance*

YesNoNot Applicable
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 2023? (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 2023? (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 2023? (If all year, enter 12)
Dependent #3s SSN
Example: xxx-xx-xxxx
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 2023? (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 2023? (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
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 2023
Upload a copy of your daycare form here.

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How would you like to receive your tax refund?

Check (Only available for in office visits)Direct DepositPrepaid CardRefund Advance $500-$7,000
Name of Bank
Which type of account would you like your refund deposited into?

Checking AccountSavings AccountOther
Routing Number
Bank Account Number
Can someone else claim you as a dependent?

YesNo
Did You Receive Unemploment Benefits in 2023?

YesNo
If Yes, Upload Taxpayer and/or Spouse Documents

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Did you have health insurance in 2023?

YesNo
Did you have health insurance for the entire year?

YesNo
Who was your insurance cover through in 2023?
Was your insurance through your employer?

YesNo
Was your insurance through Medicaid?

YesNo
Was your insurance through the Affordable Care Act (The Marketplace)?

YesNo
Did your dependents have health insurance for the entire year?

YesNoNot Appliable
Upload Taxpayer & Dependent(s)Insurance Documents

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Was YOUR DEPENDENTS' insurance through Medicaid?

YesNoNot Applicable
Was YOUR DEPENDENTS' insurance through the Affordable Care Act (The Marketplace)?

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

YesNo
Were you or any of your dependents in college in 2023?

YesNo
Did you trade any Virtual Currency

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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Are you interested in AUDIT PROTECTION?

YesNo
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

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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)

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

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Date

MonthDayYear
Date
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