Intake Form2

Health Insurance

Select all health insurances for the calendar year. Upload corresponding forms as noted.
Form 1095-A,B or C Health Coverage
Upload Form 1095-A,B,or C

Form 1095,-A, B or C Health Coverage
Cancel of
MASS Health Insurance
# of Months Insured
At End of Calendar Year
Other Health Insurance
Health Insurance Name*
Number of months insured at end of calendar year *
Health Insurance ID#
Upload Health Insurance Document

Health Insurance
Cancel of
Do you and your dependents have the same health insurance?

Yes No

Cryptocurrency
I/we have Buy, Sell, Acquire or exchange virtual currency (ie. Bitcoin)?

Yes. (If your ONLY transactions involving virtual currency were purchases with real currency ($$$) you are NOT required to answer yes) No
Did you receive a 1099-NEC for mining cryptocurrency

Yes No
Upload Form 1099-NEC

Cancel of
Did you receive a form 8300 for receiving more than $10,000 in cryptocurrency?

Yes No
Upload Form 8300

Cancel of

Banking Information & Signature

This is the account that you will receive a direct deposit for refunds if applicable.
Direct Deposit Account
Bank Account No:   account number
Routing Number:   routing number
Checking Account   Savings Account
How did you hear about us?

I'm an existing client Google Advertisement Referral from friend or family member
Enter Referrals Name. Referrals receive $25 off their tax services.

First Name Last Name
Tax Payer Signature *
Date *

Month Day Year
Date

Complete

If you have items you have not completed yet, click "Save" to return another time. A return link will be sent to the email you provided on page 1 of this form. If you are DONE, enter any final notes below you wish the accountant to be aware of then hit "Submit". One of our representatives will contact you via phone or email.
Notes to Accountant
Should be Empty:

INTAKE FORM