TaxClient Intake Form

Who did you speak with?

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

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

Alternative Phone Number

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

Did someone (a client) refer you? Type their name or type "no"

Tax Payers Date of Birth

Tax payers Email

example@example.com

Tax Payers Social Security Number

How many W2's Does The Tax Payer Have?

Bank Information ( We only do direct deposit)

Name of Bank

Routing Number

Bank Account Number

Spouse's Full Name

Spouse's Phone Number

Spouse's Date of Birth

Spouse's Social Security Number

How many W2's Does Your Spouse have?

Spouse's Email Address

Preferred Method of Contact

Do you own a business and/or were you self employed?

What Type of Self Employed Work?

How much profit was made in 2022 for your business?

Do you certify the profit made in 2022 is true, accurate and is given to use as a source of income for your 2023 Federal and State return?

Did you incur material expenses to operate your business in 2022?

How many dependents are you claiming?

Dependent #1 Full Name

Dependent # 1 Date of Birth

Dependent # 1 Social Security Number

What is the relationship to dependent # 1?

How many months did dependent #1 live with you in 2022?

Dependent # 2 Full Name

Dependent # 2 Date of Birth

Dependent # 2 Social Security Number

What is the relationship to dependent # 2?

How many months did dependent # 2 live with you in 2022?

Dependent # 3 Full Name

Dependent # 3 Date of Birth

Dependent # 3 Social Security number

What is the relationship to dependent # 3?

How many months did dependent # 3 live with you in 2022?

Are there any dependents in daycare? If so, please upload the form you receive from the daycare provider.

If you had insurance through the marketplace, did you receive a 1095A Health Insurance Marketplace statement? (Not providing form IRS could delay your refund)

Have you ever been denied the Earned Income Tax Credit (EITC)?

Did you or spouse attend college in 2022?

Did any of your dependents attend college in 2022?

Do you have a Form 1098T (Tuition Statement) for either you, your spouse and/or dependents?

Select proof of business you have today?

All IRS prescibed forms. (Example W2, 1099 misc, 1099 INT....) FYI if you are returning client I will only need updated documents as long as ID is not expired on file.

Please check and confirm all numbers including social security numbers, bank account information before submitting. Please check and confirm all names are spelled correctly and all information is correct.

All files will be emailed to the person you selected in the first question:

Johnna Roberson yourdebtstopsnow@gmail.com

Kellie Jackson kjcrediteducation@gmail.com

I confirm and agree that all information is correct.

I am giving No Debt Financial Services permission to prepare all forms related to my tax return and I have signed all necessary forms to file my income tax return electronically. I take full responsibility for the accuracy of this client intake form and understand that No Debt Financial Services holds no responsibility for any misrepresentation or false claims.

Signature

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