Tax Intake Form

Thank you for choosing A. MOORE TAX SOLUTIONS

To ensure we have the information we need to best serve you, please take a few moments to fill out the form below.

If you have any questions, please feel free to contact us at any time at info@amooretaxsolutions.com or by phone at 404-510-9149.
If someone referred you, please type his or her name.
If a business referred you, please type the name of the business.
Are you interested in being a referral agent? Click the link below to sign up.

https://www.cognitoforms.com/AlishaMoore2/ReferralAgentSignUp
Are you interested in being a business referral agent? If yes, Click the link below to sign up.

https://www.cognitoforms.com/AlishaMoore2/BusinessPartnerReferralProgramSignUp
Are you trying to buy a new home within the next 2 years?*

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Are you interested in credit repair?*

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Are you interested in Business or Personal Funding?*

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Are you interested in Bookkeeping services?*

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Are you interested in AUDIT PROTECTION?*

YesNo
Please expand each section to enter your information.

Tax Payer Information
Tax Payer's Name*

First NameLast Name
Taxpayer's Date of Birth*
Example: 01/01/2001
Taxpayer's Email Address*
example@example.com
Taxpayer's SSN*
Example: xxx-xx-xxxx
Taxpayer's Phone Number*
Example: xxx-xxx-xxxx
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer's Job Title
Do you own a business? If yes, please complete the profit and loss statement at the end of the intake form.*

YesNo
Are you married?*

YesNo
Do you have dependents?*

YesNo
Do you have an IP PIN? If yes, Please enter it below.

Enter your dependents information here:

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

YesNo
Upload a copy of your daycare form here.

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Acknowledgement & Signature
CLIENT NON PAYMENT/OFFSET CLAUSE

At A. MOORE 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 within 30 days legal actions will be sought to resolve payment.
Taxpayer's Signature

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I am giving A. MOORE TAX SOLUTIONS, permission to prepare all forms related to my tax return; to apply for and secure Refund Anticipation Checks and Refund Anticipation Loans 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 A. MOORE TAX SOLUTIONS and/or associated affiliates hold no responsibility for any misrepresentation or false claims.
Taxpayer's Signature

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

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