Tax Client Intake

DateTime

Name:

First NameLast Name

Social Security Number:

example: 123-45-6789

Date of Birth:

Example: 02/01/0123

Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Email:

example@example.com

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Referral Name: /How You Found Us:

example: Shamar, Banner on Bankhead, Some Lady on Campbellton

Occupation:

Check all that apply...

What is your EIN? (If you do not have one, add your social instead)

Example: 56-1307127 or N/A (If it's not applicable)

Did you receive a W-2 or 1099? (If yes, you will be asked to upload your forms below.)

Did you receive social security benefits in 2025? (If yes, you will be asked to upload your 1099-SSA below.)

Did you receive unemployment benefits in 2025? (If yes, you will be asked to upload your 1099-G below.)

Were you married as of 12/31/2025 ?

If you have any dependents please list how many?

Please list dependent information: (Need Names, Date of Birth, Social Security Number & dependent's relationship to you):

Did the primary taxpayer (or any dependents) receive a Form 1095-A Health Insurance Marketplace Statement?

DO YOU RECEIVE AN IP PIN?

IF YES, PLEASE PROVIDE IP PIN NUMBER;

Please upload the following files: (License or ID, Social Security Card, W-2 Forms, 1099s or any other dependent documents (if applicable).

If using Direct Deposit to receive your Tax Refund, please provide Banking information (Routing and Account Number):

Example: Routing # 54637346 , Account # 99876545 or N/A (If it's not applicable) We have cards if you do not have an account.

By Signing, I certify all information is true and correct to the best of my knowledge. Signature: