Client Intake Form 2023

Client Intake Form

Tax Period Ending December 2023
Tax Payer Name*

First NameLast NameSuffix
Tax Payer Email Address Email Tax Payer Phone Area Code Phone Number
Filing Status*

SingleMarried filing JointMarried filing SingleHead of HouseholdWidow/Surviving Spouse
Taxpayer

Only Enter Taxpayer Information Here

Enter Tax Payer*

Tax Payer

First Name

Last name

Full Address

Date of Birth

Social Security Number

Occupation/Job Title

IP PIN (if none assigned by IRS put NONE)

Spouse ONLY FOR MFJ, MFS or Widow filers

Spouse

First Name

Last name

Full Address

Date of Birth

Social Security Number

Occupation/Job Title

Phone

IP PIN (if none assigned by IRS put NONE)

Upload your (and Spouse if applicable) Drivers License/State ID here:*

Must upload identification for tax preparation; must upload Spouse's if filing married filing joint or widowed
Cancelof
Upload your (and Spouse if applicable) Income documents here:*

W2's, All 1099's (mortgage, school, taxes, interest, retirement, social security etc), PnL,/Income Statements,
Cancelof
Bank Name:   Type a label
Bank Account Type (checking/savings):

Bank Routing #:
Confirm Bank Routing # :

Bank Account #:   Type a label
Confirm Bank Account #
Dependents

(If more than 5 dependents, add additional in comment section below)

Enter Dependent Information here:

Dependent #1

Dependent #2

Dependent #3

Dependent #4

Dependent #5)

First Name

Last Name with suffix if applicable

Social Security Number

Date of Birth

Relationship to Taxpayer

IP PIN if assigned by IRS

Is Dependant Disabled

Upload Dependent Documentation here:

example: Social Security Cards, daycare receipts, proof of relation, etc as needed
Cancelof

Tax Prep payment from refund? Audit Protection? Fast Cash Advance?*

	Yes	No
Would you like to pay for your tax preparation fees from your refund?
Would you like Audit Protection Plus? ($109.95, protects you in case of audit)

Checklist*

	Yes	No
Participate in HSA with your Employer? If yes have you uploaded FORM 5498?
Are you or your spouse active military or a veteran?
Did you participate in Marketplace via healthcare.gov. If yes is your FORM 1095-A
Referred to Smith's Tax Service? If yes list refer's name below (first time filers only)

Name of referral person

First NameLast Name
Comments
Enter any additional information or notes to tax preparer not listed above
Should be Empty:

Client Intake Form