CLIENT INTAKE FORM

CLIENT INTAKE FORM

ALL INFORMATION GIVEN IS FOR INCOMETAX PURPOSES ONLY AND WILL BE KEPT CONFIDENTIAL
NAME
DATE OF APPLICATION

MonthDayYear
TAX YEAR
SOCIAL SECURITY NUMBER
DATE OF BIRTH

MonthDayYear
PHONE
Please enter a valid phone number.Format: (000) 000-0000.
EMAIL
example@example.com
ADDRESS
SEX
DID YOU RECEIVE 1095A - OBAMA CARE?
OCCUPATION
YOUR INCOME
PHOTO OF W2/1099

Cancelof
DID YOU RECEIVE 1099G - UNEMPLOYMENT?
PHOTO OF 1009-G FORM

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STIMULUS
STIMULUS #1 REQUIRED
HOW MUCH DID YOU GET ON STIMULUS #1?
DATE YOUR FIRST STIMULUS

MonthDayYear
1095A FORM

Cancelof
STIMULUS #2 REQUIRED
HOW MUCH DID YOU GET ON STIMULUS #2?
DID YOU RECEIVE CHILD TAX CREDIT DURING 2021?
IP PIN-PROTECTION PIN (IRS SENT YOU)
SPOUSE'S IP PIN-PROTECTION PIN (IRS SENT YOU)
DRIVER'S LICENCE OR ID

Cancelof
SPOUSE'S DRIVER'S LICENCE OR ID

Cancelof
SPOUSE'S INFORMATION
SPOUSE'S NAME
SPOUSE'S DATE OF BIRTH

MonthDayYear
SPOUSE'S SOCIAL SECURITY NUMBER
SPOUSE'S SEX
SPOUSE'S OCCUPATION
SPOUSE'S PHONE
Please enter a valid phone number.Format: (000) 000-0000.
SPOUSE'S EMAIL
example@example.com
SPOUSE'S INCOME
PHOTO OF W2/1099

Cancelof
DID YOUR SPOUSE RECEIVE 1099-G | UNEMPLOYEMENT
PHOTO OF 1099-G FORM

Cancelof
DEPENDENTS
DEPENDENT #1
DATE OF BIRTH

MonthDayYear
SOCIAL SECURITY NUMBER
DEPENDENT #2
DATE OF BIRTH

MonthDayYear
SOCIAL SECURITY NUMBER
DEPENDENT #3
DATE OF BIRTH

MonthDayYear
SOCIAL SECURITY NUMBER
EVIDENCE OF CHILD/DEPENDENTS

Examples of evidence: Birth certificate, passport, school records
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OTHER PROOF

Ex. Rental agreement, home ownership, etc.
Cancelof
WAS YOUR CHILD HOME SCHOOLED DURING 2020?
DID YOU OR ANYONE IN YOUR FAMILY HAVE COVID-19 2020?
UPLOAD PROOF OF COVID-19

Cancelof
WHO WAS SICK WITH COVID DURING 2020?
REFERRED BY:
DIRECT DEPOSIT INFORMATION
BANK NAME:
ACCOUNT TYPE:
ROUTING NUMBER:
ACCOUNT NUMBER:
By signing this form I certify that all the information is correct and I allow Tax Services By Santos to prepare and file my tax returns.
Signature
Should be Empty:

CLIENT INTAKE FORM

YOUR INCOME

STIMULUS

SPOUSE'S INFORMATION

SPOUSE'S INCOME

DEPENDENTS

REFERRED BY:

DIRECT DEPOSIT INFORMATION