HG CLIENT INTAKE FORM

HALLER GROUP CLIENT INFORMATION

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WHAT SERVICES ARE YOU INTERESTED IN?

Individual Tax PreparationBusiness Tax PreparationTax PlanningBusiness ConsultingBookkeepingPayroll ServicesRetirement Planning
WHAT TAX YEAR ARE WE STARTING WITH?
Example: 2025 Tax Year is in the 2026 Calendar Year
WHEN WOULD YOU LIKE SERVICES TO START?
Example: Immediately or Next Month
WHAT ACCOUNTING SYSTEM DO YOU USE?
WHAT PAYROLL SYSTEM DO YOU USE?
GENERAL INFORMATION
Taxpayer Name

First NameLast Name
E-Mail
example@example.com
Phone No

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
SSN
FAMILY INFORMATION

For the following questions, select "Yes" or "No".
DO YOU HAVE A SPOUSE?

YESNO
Spouse Name
Spouse Phone

Area CodePhone Number
Spouse E-Mail
example@example.com
Date of Birth

MonthDayYear
Date
SSN
DEPENDENT INFORMATION
DO YOU HAVE CHILDREN/DEPENDENTS?

YESNO
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
SSN
Relationship
Example: Son or Step-daughter
Dependent of
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
SSN
Relationship
Example: Son or Step-daughter
Dependent of
BUSINESS INORMATION
DO YOU OWN A BUSINESS?

YESNO
Legal Business Name
DBA
Business E-Mail
example@example.com
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Incorporation

MonthDayYear
Date
Tax ID
Number of Employees
Calendar / Fiscal Year?
If Fiscal, What is Year End?
Business Type

Sole ProprietorPartnershipC CorpS Corp
Primary Business Activity
OFFICER INFORMATION
Name
Title
Percent Ownership
Name
Title
Percent Ownership
Name
Title
Percent Ownership
MONTHLY SERVICES

Did you discuss a monthly engagement with Haller Group?
Did you discuss the option for monthly services with Haller Group?

YesNoWe will discuss at a later time
By selecting "No", you agree to an hourly rate of $375 per hour for tax preparation and/or tax planning services.

NOTE: This is NOT a legally binding engagement of services. An engagement letter outlining Haller Group's terms and the nature and extent of the services Haller Group will provide will be sent to you via email for e-signature upon the submittal of this intake form.
Which Payment Type?

Checking/Savings Account (ACH)Credit CardI'll Provide This Information Later
Name on Account
Account Number
Routing Number
Billing Address
Name of Bank
Bank City/State
When you submit this form, you will be redirected to Adobe Sign to submit your Credit Card information.

For your security, credit card information must be collected through a PCI-compliant platform. When you choose the credit card billing option, we redirect you to Adobe Acrobat Sign—a secure and encrypted system trusted for handling payment authorizations.

Adobe Sign allows you to safely enter your card details and electronically sign the authorization form. Once completed, the form is securely sent to our team so we can set up your recurring monthly billing. This ensures your payment information stays fully protected. NOTE: The linked form is a secure form with 2 step authentication to ensure the safety of your sensitive information. It will ask you to verify your email before it successfully sends.
NOTE: This is NOT a legally binding engagement of services. An engagement letter outlining Haller Group's terms and the nature and extent of the services Haller Group will provide will be sent to you via email for e-signature upon the submittal of this intake form.

Agreeing to the above terms & conditions, authorizes monthly scheduled charges to your credit card or ACH bank draft only after a signed agreement to services rendered is established. The agreed monthly amount for all services is outlined in the client engagement letter. No payment will be taken until the engagement letter is signed. The below signature only acknowledges and authorizes Haller Group to collect your payment information.
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HALLER GROUP CLIENT INFORMATION

GENERAL INFORMATION

FAMILY INFORMATION

DEPENDENT INFORMATION

BUSINESS INORMATION

OFFICER INFORMATION

MONTHLY SERVICES

UPLOAD DOCUMENTS