New Beginnings Tax Solutions Client Intake Form
Please fill in the details below:
Name
*
First Name
Last Name
E-mail
*
Your E-mail Address
Phone Number
*
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Occupation
Status
*
Single
Married
Spouse Details
If you are married, please fill in the section below:
Spouse Name
First Name
Last Name
Spouse Date of Birth
-
Month
-
Day
Year
Date
Spouse Social Security Number
Will you claim dependents?
*
Yes
No
Dependent Details
If you are claiming dependents, please fill in the section below:
Dependent 1
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Social Security Number
Dependent 2
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Social Security Number
Dependent 3
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Social Security Number
Dependent 4
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Social Security Number
Childcare Expenses
Please enter expense details below, if applicable:
Childcare Expenses List
Rows
Description
Cost
1
2
3
4
5
2020 Total Childcare Expenses
College Expenses
Please enter expense details below, if applicable:
College Expenses List
Rows
Description
Cost
1
2
3
4
5
2020 Total College Expenses
Taxpayer(s) certification
*
I certify that all information entered above is valid and true. (Individual)
I certify that all information entered above is valid and true. (Spouse)
Fast Cash Advance Loan
This loan is not credit based. You will get approved or denied based on your tax refund. The minimum is $500 and the maximum is $6,000.
Would you like to apply for the Fast Cash Advance Loan?
*
Yes
No
Please verify that you are human
*
Signature (Individual)
*
Signature (Spouse)
Print Form
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