THP CLIENT INTAKE FORM

Tax Payers Name

First NameLast Name

If you have an IRS issued PTIN enter the number; If you do NOT have a PTIN enter N/A

PTIN #

Best time to contact you

:HourMinutesAM/PM Option

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Taxpayer's Phone Number

Example: xxx-xxx-xxxx

Taxpayer's Email Address

Taxpayer's Job Title

Taxpayer's Date of Birth

Example: 01/01/2001

Taxpayer's SSN

Example: xxx-xx-xxxx

Taxpayer's Driver's License

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What is your Filing Status?

Can someone else claim you as a dependent?

Do you need to file an Amended tax return, or back taxes for the past 3 years?

Do you own a business (self employed)?

If you do not officially own a business, but sold products or provided services are you interested in business construction?

Taxpayer's W-2(s) or 1099(s)

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Only as it applies: Self-Employment Expense Log, Summary of Income, Business License, Bank Statements, Receipts, etc

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What is your Marital status as of December

Spouse's Full Name (if applicable)

First Name

Last Name

Spouse's Date of Birth

Example: 01/01/2001

Spouse's SSN

Example: xxx-xx-xxxx

Spouse's Phone Number

Example: xxx-xxx-xxxx

Spouse's Email Address

Example: example@example.com

Spouse's Job Title

Did your spouse receive a W-2 or 1099?

Did you or your spouse receive Unemployment Compensation (Form 1099-G)?

Did you or your spouse receive Unemployment or Social Security Income?

Did you or your spouse take an early withdrawal from your Retirement account?

Did you or your spouse receive any Economic Stimulus Payments? If so, which round did you receive?

Did you and/or your spouse own a home?

Were you and/or your spouse first time home buyers this year (20223)?

Did you and your spouse live apart during the year?

Did you pay over half the expenses of maintaining your residence for the entire year?

Are you on any Government Assistance

Did you receive any Child Tax Credit Advance Payments? Have you ever been denied the Earned Income Tax Credit (EITC)?

How many dependents are you claiming?

Dependent #1

First NameLast Name

Dependent #1's Date of Birth

01/01/2001

Dependent #1's SSN

What is Dependent #1's Relationship to you (son, daughter, etc.)?

How many months did Dependent #1 live with you in 2023? (If all year, enter 12)

Dependent #2

First NameLast Name

Dependent #2's Date of Birth

Example: 01/01/2001

Dependent #2's SSN

Example: xxx-xx-xxxx

How many months did Dependent #2 live with you in 2023? (If all year, enter 12)

What is Dependent #2's Relationship to you (son, daughter, etc.)?

Dependent #3

First NameLast Name

Dependent #3's Date of Birth

01/01/2001

Dependent #3's SSN

Example: xxx-xx-xxxx

How many months did Dependent #3 live with you in 2023? (If all year, enter 12)

What is Dependent #3's Relationship to you (son, daughter, etc.)?

Dependent #4

First Name

Last Name

Dependent #4's Date of Birth

01/01/2001

Dependent #4's SSN

Example: xxx-xx-xxxx

What is Dependent #4's Relationship to you (son, daughter, etc.)?

How many months did Dependent #4 live with you in 2023? (If all year, enter 12)

Can any of your dependents be claimed by someone else?

If yes, which dependent can be claimed by someone else?

Dependent(s) Birth Certificate(s)

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Taxpayer's and Dependent(s ) Social Security Card(s)

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Dependent(s) Proof of Residency (Lease/Utility Bill/Shot Record/School Report /card)

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Did you pay any Daycare expenses? If so, upload a copy of your Childcare statements

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Did you pay for health insurance? If yes, upload documents for you and your Dependents

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Were you or any of your dependents in college in 2023? If so, upload Form 1098-T for you and/or your dependents from the college or university attended.

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Name of Bank

Which type of account would you like your refund deposited into?

Other

Bank Routing Number

Bank Account Number

Do you and/or your spouse owe any of the following:

How would you like to receive your tax refund-OR- How would you like to pay for your Tax Services?

PLEASE TAKE A FEW MOMENTS TO LOOK OVER ALL REQUESTED INFORMATION TO MAKE SURE YOUR INFORMATION TO MAKE SURE YOUR INFORMATION IS COMPLETE AND ACCURATE.

CLIENT NON PAYMENT/OFFSET AGREEMENT:

Our goal is to ensure the very best tax experience for all of our clients. However, we do understand that situations arise unexpectedly. If your refund is offset by the IRS for any reason such as student loans or child support, or if your check is mailed and not directly deposited, you are still responsible and obligated to pay our company all fees associated with filing your tax return.

I acknowledge that if payment is not made in full within 30 days then legal actions will be sought to resolve payment. I am giving THP Consultation Services Powered By Wilson Consulting Services and/or associated affiliates permission to prepare all forms related to my tax return. I will take full responsibility for the accuracy of the information on this Client Intake Form and understand that THP Consultation Services Powered By Wilson Consulting Services will not be responsible for any misrepresented data or false claims. By signing this agreement you acknowledge and accept the terms and conditions.

Taxpayer's Signature

Date

Spouse's Signature (If not applicable, leave blank)

Date

Are you interested in the Cash Advance option? And, are you interested in the AUDIT PROTECTION?

Are you interested in Life Insurance?

Are you interested in Credit Repair?

Are you trying to buy a new home within the next 2 years?

How did you hear about us?

If someone referred you, enter his or her name here.

CLIENT INTAKE FORM

We want to thank you for choosing THP Consultation Services for your Personal and Business tax preparation needs. We truly appreciate your business and do not take it for granted. Please take a moment to fill out the form so we can better assist you with filing your taxes.

Personal Information

Business Owner/Self-Employment

Marital Information

Dependents

Bank Information