Tax Client Intake Form

Tax Client Intake Form
Filing Status

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower
Where is the other parent?
Do you receive Child Support?

YesNo
Is there another taxpayer at your residence that contributes to your bill/expenses?

YesNo

Enter your dependents here

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

General Expenses

	Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Last Year Tax Preparation Fees
Investment Expenses

Self Employment Information (Skip this section if it does not apply to you.)
Legal Business Name
What year did this business start?
EIN Number *If Applicable*
What service/product do you offer?
Are your business expenses and income organized?
Do you own a business credit card?

YesNo
Did you receive any business loans and/or grants last year? List the source and amounts.

Payment Details
Would you like a Refund Advance?*

YesNo
If yes, would you like a $1k Interest Free Advance or More (Interest Applied)?

YesNo
Would you like to pay out of pocket?

No, Pay from Tax RefundYes, Pay Upfront

Documents Upload, Acknowledgment & Signature
Please Include:
- Your Driver's License/ID
- SSN Card and/or Birth Certificate for Dependents (if available)
- All Tax Forms Received
- Child Care Provider record (if applicable)
- Rent/Utility Bill (If Filing Head of Household)
Upload Documents Here

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Additional comments
I confirmed that all information I entered here is accurate and true. I allow Dash Professional Services 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 of Dash Professional Services. By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed

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Taxpayer Signature

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Date Signed

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Spouse Signature

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