Tax Intake

CLIENT FORM
How did you hear about us?
How would you like to finish the prparation of your tax retun?

Other
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?

Other
What tax year are you submitting today? (Please look at your tax documents and select the correct year)

Other
Did you trade any Virtual Currency
Are you interested in AUDIT PROTECTION?
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
Taxpayer's Email Address
example@example.com
Type a question
Gender
Dependent on another?
Legally Blind?
Disabled?
Text Message?
Taxpayer's Cell Phone Carrier
Example: At&t, C-spire, ect
Is Taxpayer Self Employed?
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?
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 Social Security Number
Example: xxx-xx-xxxx
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 Email Address
example@example.com
Gender
Dependent on another?
Legally Blind?
Disabled?
Text Message?
Spouse's Cell Phone Carrier
Example: At&t, C-spire, ect
Is Spouse Self Employed?
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?
Filing Status
What is your marital status as of December
Did you support a child or family member for more than 6 months out of the year?
Did you pay over half the expenses of maintaining your residence for the entire year?
Bank Information

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

Other
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)?
Received health care coverage from the government such as Medicaid, Medicare or Veterans Benefits?
Purchased private health insurance (NOT through the Marketplace) for the entire year?
Purchased health insurance through the "Marketplace" (Form 1095-A)?
At least one family member (including taxpayer) did not have health care coverage at anytime during the year?
Upload Taxpayer & Dependent(s)Insurance Documents

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Dependents
Have you ever been denied the Earned Tax Credit (EITC)?
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 2025? (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 2025? (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 2025? (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
What is Dependent #4's Relationship to you (son, daughter, etc.)?
Dependent #4's SSN
Example: xxx-xx-xxxx
How many months did Dependent #4 live with you in 2025? (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 2025? (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.
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 2025?
If Yes, Upload Taxpayer and/or Spouse Documents

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Are you receiving any Government Assistance
How many W-2's Does the Taxpayer Have For 2025?
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 2025?
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 2025?
Please Upload

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Please Upload

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Do you have any additional income in 2025? (SSA1099, Alimony, Gambling Income, IRA, Pension, Railroad Retirement RPB1099, etc)
Please Upload

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Please Upload

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Were you or any of your dependents in college in 2025?
Credits
Do you have a 1098-T Form for either you or your dependents?
If you have a 1098-T form, upload it here.

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Itemized Expenses
Do you have any Medical and Dental Expenses?
Type a question
Do you have any Taxes Paid?
If yes, please enter the total.
Do you have any Interest Paid?
If yes, please enter the total.
Do you have any Gifts to Charity?
If yes, please enter the total.
Do you have any Other Miscellaneous Deductions?
If yes, please enter the total.
Do you have any Other Expenses?
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
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
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)
Spouse's Signature (If no spouse, leave blank)
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