Tax Preparation Intake Form

Tax Preparation Intake Form
Tax Preparer Name*
Year of Tax Prep*
Type of Client*

NewReturning, with NO changes to address or tel nbr.Returning, WITH CHANGES to address or tel nbr.

Tax Refund Options
Do you want the REFUND ADVANCE LOAN? Receive Up to $7,500 in 24 Hours*

YesNo
How would you like to receive your refund?*

Refund Transfer Direct DepositRefund Transfer Prepaid CardRefund Transfer Paper Check
Bank Name
Routing Number
Please Double Check Your Entry
Checking/Savings Acct Number
Please Double Check Your Entry

Dependents
Do you have any dependents?*

YesNo
How many dependents do you have?*
If none, please enter 0
Do you have your dependents Social Security cards or Birth Certificates ?*

YesNo
Do you have any expenses for child care?*

YesNo
Child Care Provider Name
Amount Paid to Child Care Provider for the Year
Please Enter Whole Dollars
Does your dependents have school tuition expenses?*

YesNo

Enter your dependents here. If none, enter NA*

Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?*

Business Owners & Independent Contractors Only
Please click on the link to enter your business expenses for the current tax year. This document must be fully completed.

Business Profit & Loss Statement

Audit Protection
Are you interested in Audit Protection for $79? Fee deducted from refund.*

YesNo

Client Offset/Non-Payment Clause
At SOUTHEAST TAX SERVICES, LLC, we strive to assist all of our clients in their tax needs. However, we understand that situations arise. If your refund is offset by the IRS, Student Loans, Child Support or if your check is mailed, you are still obligated to pay the preparation fees associated with filing your tax return.

By signing this agreement you acknowledge that payment must be made in full with in 30 days to SOUTHEAST TAX SERVICES, LLC.
I have read the Offset Clause.*

Yes

Acknowledgment & Signature
- I, hereby, state that all the information above is true to the best of my knowledge and give permission to SOUTHEAST TAX SERVICES, LLC. to prepare all forms related to my tax return.
- I take full responsibility for the accuracy of this form and understand that SOUTHEAST TAX SERVICES, LLC and/or associated affiliates hold no responsibility for any misrepresentation or false claims.
- I give permission to SOUTHEAST TAX SERVICES, LLC. to capture my sensitive data like personal ID, government ID, social security number (SSN), and other information.
- If filing a joint return, each spouse authorizes SOUTHEAST TAX SERVICES, LLC. to share information with each other.
- By signing below, you acknowledge that you have read and understood your responsibilities and SOUTHEAST TAX SERVICES, LLC responsibilities in preparing this tax return.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

Clear
Date Signed

MonthDayYear
Date
Spouse Signature

Clear
Please verify that you are human*
IMPORTANT LAST STEP

Once you hit the SUBMIT button, you will be immediately redirected to securely upload your tax documents. These documents are required for accurate tax preparation.
Should be Empty:

IMPORTANT LAST STEP