Tax Preparation Client Intake Form

Tax Preparation Client Intake Form

Please complete EVERYTHING that applies to you and submit all your documents. Please wait until you have ALL your documents before submitting your intake form.
Type of Client*
Tax Year needing prepared. You will need to submit a form for each year needing prepared.*

20242023202220212020201920182017
Do you owe the IRS, your state, child support, student loans, government, etc?*
Do you receive any government assistance?*
Did you receive the Employee Retention Credit (ERC Credit) or the Fuel Tax Credit?*
Did you work for any delivery services such as Uber, Door Dash, Lyft, etc.?*
At any time during 2023, did you receive (a) as an award, reward, or payment for property or services or (b) sell, exchange, gift, or otherwise dispose of digital asset (or financial interest in digital asset)?*
Filing Status for 2024*
Do you have an IP Pin?*

TAXPAYER INFORMATION
Name*

First NameMiddle NameLast NameSuffix
SSN/ITIN*
Date of Birth*

MonthDayYear
Date
Cell Number*
Please enter a valid phone number.
Cell Carrier (ex. Verizon)*
Work Number
Please enter a valid phone number.
Email*
example@example.com
Present Employer*
Occupation*
Marital Status as of December 31, 2023*
Employment Status*
Are you a U.S. citizen?*
Address*

Street Address

Apt.

CityState / Province

Postal / Zip Code
Can anyone else claim you or are you listed as a dependent on someone else's tax return?*
Have you had any credits disallowed or reduced in previous years? *

SPOUSE INFORMATION
Name

First NameMiddle NameLast NameSuffix
SSN/ITIN
Date of Birth

MonthDayYear
Date
Cell Number
Please enter a valid phone number.
Cell Carrier (ex.Verizon)
Work Number
Email
example@example.com
Present Employer
Occupation
Employment Status
Are you a U.S. citizen?
Address

Street Address

Apt.

CityState / Province

Postal / Zip Code
Can anyone else claim you or are you listed as a dependent on someone else's return?
Have you had any credits disallowed or reduced in the previous years?

Enter your dependent information here. Do not enter spouse information.

If you had Marketplace insurance at anytime last year, you are REQUIRED to provide a form 1095-A or your refund will be delayed!*

	Yes/No	Marketplace	Private/Other Healthcare Insurance	Medicaid	ALL Kids	Medicare
Taxpayer
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

INCOME AND WAGES
If you were an employee, contractor, received unemployment or received any other income of any kind not listed, you can take photos and/or upload documents below.
Photo Upload
UPLOAD documents here.

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IDENTIFICATION
For identification purposes, upload and/or take photos of the following documents. If our office has this information from previous years, you will still have to provide it. You can take photos and/or upload the documents below.
For taxpayers: Unexpired Driver's license or state ID
For Taxpayer claiming dependents:
-Birth certificates to show relationship to taxpayer
-Lease agreement or utility bill from last year
-Proof dependent lived with you last year...school records, health insurance statement, etc.....has to show dependent's address is the same as yours.
Please provide a copy of your unexpired State ID/ License, Birth Certificate, and Social Security cards
UPLOAD documents here.

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BANKING INFORMATION
How would you like to receive your tax refund?*

Prepaid CardCheckDirect Deposit (Availability of funds depends on your bank.)N/A
Would you like to apply for the Fast Cash Advance Loan? *
*Loan approval is based on the bank and IRS decision.
Would you like your Prepaid card or check sent overnight for an extra $50 deducted from your refund?*
If your tax preparation fees will be deducted from your refund, please provide the answer to the following security question:
What high school did you attend? Type a label*
I hereby authorize Exquisite Tax Services to initiate automatic deposits to my account at the financial institution named below. I also authorize Exquisite Tax Services to make withdrawals from this account in the that a credit entry is made in error.
Further, I agree not to hold Exquisite Tax Services responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account.
This agreement will remain in effect until Exquisite Tax Services receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form.
Bank Name   Type a label
Routing Number
Account Number
Would you like your refund deposited in