• Tax Preparation Client Intake Form

  • Were you referred by anyone?*
  • What year needs to be filed?
  • Filing Status*
    • Taxpayer Information 
    • Date of Birth*
       - -
    • Format: (000) 000-0000.
    • Are you a full-time student?*
    • Are you totally and permanently disabled?*
    • Are you legally blind?*
    • Can you be claimed as a dependent on someone else's tax return?*
    • Spouse Information 
    • Date of Birth
       - -
    • Format: (000) 000-0000.
    • Are you a full-time student?
    • Are you totally and permanently disabled?
    • Are you legally blind?
    • Can this person be claimed as a dependent on someone else's tax return?
    • Dependents 
    • Rows
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    • Rows
    • Tax Related Questions 
    • Employment Status*
    • Do you owe any debt to IRS, Child Support, Student Loans, Previous Tax Year Owed, etc.*
    • Did you receive health insurance through the Marketplace and have received a 1095-A form in the mail?*
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    • Are you contributing to 401k or other pre-tax account?*
    • Does your dependents have tuition expenses?
    • Do you have any expenses for child care?
    • Do you have energy star rated improvements to your home?
    • Are you currently renting?*
    • Do you have your own home?*
    • Do you have documents that shows you paid for property taxes?
    • Did you sell any stock?*
    • Did you take money from your 401?*
    • Did you receive a federal tax return last year?*
    • Are you a victim of identity theft?*
    • Self-Employed Information 

    • Please fill-up the information within the current year only.

    • Did you receive any household wages that were not reported on a W2?
    • Upload Tax Documents 
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    • Direct Deposit Information 
    • Are you interested in a Next Day Advance up to $7,000? *Approval is at bank's discretion. Advances are no longer available after March 1st. If it is after March 1st, please select No.*
    • ADD-ON OPTIONS 
    • Acknowledgment & Signature 

    • I acknowledge that all information provided to Teem Empire Consulting LLC is hereby accurate and true to the best of my knowledge. I understand that I am required to provide any supporting documentation to validate the information provided. I understand that knowlingly providing false information on my tax return and reporting it to the IRS, that I am taking part in a potentially criminal penalty situation and is punishable by law including but not limited to; court, restitution fees, and possible imprisonment. I waive, Erica McClearin, Teem Empire Consulting of any error due to incorrect information provided by me. 

      • I allow, Erica McClearin to capture my sensitive data like personal id, government id, social security number (SSN), and other information.
      • I have read the terms and conditions and privacy policy.

      • By signing below, you acknowledge that you have read and understood your responsibilities and give full permission to Erica McClearin, Teem Empire Consulting LLC to file your tax return.
    • Date Signed*
       - -
    • Date Signed
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    • Should be Empty: