Client Tax Intake Form

How did you hear about us?

Are you a NEW or EXISTING Client?*

Are you interested in Credit Repair?(Discounted if file taxes with us)*

Taxpayer Name*

First NameMiddle NameLast NameSuffix

Taxpayer Date of Birth*

Date

Taxpayer Social Security Number**

Taxpayer Occupation*

Were you previously issued an Identity Protection PIN (IP PIN) by the IRS?*

YESNO

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you need to File Previous Year Taxes?

202020212022No

Upload Previous Tax year Income Docs (ONLY IF YOU NEED TO FILE PREVIOUS YEAR)

ALL NEW CLIENTS! Please upload previous year Tax Return(ex:2022 Return)

Will you be filing a tax return with your Spouse?*

YESNO

Can another taxpayer claim you as a dependent on their tax return?*

YESNO

Did the Taxpayer work in 2023?*

YESNO

Taxpayer Photo Identification*

Taxpayer Social Security Card*

Taxpayer Income Documents*

Do you have any dependents you will claim on your 2023 tax return?*

YESNO

Please Upload Dependents Social Security Card

Dependent DOB

Please Upload Dependents Social Security Card

Dependent DOB

Please Upload Dependents Social Security Card

Dependent DOB

Did you, your spouse, or any dependents attend college in 2023?*

YESNO

Did you, your spouse or dependents receive health insurance through the Marketplace in 2023 and receive Form 1095-A?*

YESNO

Did you or your spouse receive unemployment benefits in 2023?*

YESNO

Do you rent or own your current residence?*

RENTOWN

Proof of residency for HOH(HEAD OF HOUSEHOLD) FILERS:(utility bill, lease agreement, mortgage statement, rent receipts, etc)

Did you or your spouse make payments on your student loans in 2023?*

YESNO

Did you or your spouse pay any medical or dental expenses in 2023? (this does not include insurance premiums)*

YESNO

Did you or your spouse have any gambling winnings in 2023?*

YESNO

Did you or your spouse receive social security benefits in 2023?*

YESNO

Do you or your spouse own any rental property?

YESNO

Upload Form 1099-SSA

Did you make any charitable contributions in 2023? (Goodwill, Salvation Army, Church etc.)?*

YESNO

Did you make any charitable CASH contributions of $300 or more in 2023?*

YESNO

Did you receive any earnings from interest or dividends in 2023?*

YESNOOther

Are you self-employed?*

YESNO

If YES, Whats Business Name & What does your business do?

If self-employed, how much did you make?

Do you or your spouse owe debt to any Government Agency; such as IRS, Student Loans, Child Support etc?*

YESNO

Would you like your tax refund direct deposited into your bank account?*

YESNO

Name of Financial Institution

Checking account or Savings Account

Bank Routing#

Bank Account#

Upload a screenshot of your bank account and routing number(this will avoid copying your information incorrectly)

Would you like to receive a text message when your refund is funded?*

YESNO

Taxpayer Signature

By signing, you are indicating that you agree with the above engagement letter.

CONSENT TO USE OF TAX RETURN INFORMATION

Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use, without your consent, your tax return information for purposes other than the preparation and filing of your tax return. However, federal law also prohibits us from revealing any personal or financial information to any third party. Therefore as a matter of fact, we will never reveal your financial or personal information in any way, to anyone, unless you specifically request we do so, and provide in writing to us the specific person or persons to whom you wish that disclose to be made, which is done on a wholly separate consent form from this. For the purposes of this consent form please note we are seeking consent only to satisfy requirements set forth by federal law so we may speak with you on the phone, send you email correspondences of any kind, send you mailings, newsletters, email reminders, holiday and occasional cards and greetings, and reminders of upcoming deadlines, etc. You are not required to complete this form. If we obtain your signature on this form by conditioning our service on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for a period of three years from the date you have signed the consent. The undersigned hereby consents to the use; by FINANCIAL FREEDOM CONSULTANTS, its owner, employees, and staff; of any and all tax return information pertaining to: Direct questions, inquiries or requests you make regarding your tax returns, situation, or issues. Requests you make for copies of your documents, figures, numbers, or information. Upon your direct request in order to connect you with another professional in another field or profession so you may gain further information on a certain topic not available or in the realm of expertise of this firm. Notification of important tax law changes. Notification of changes or information that will impact our engagement, such as a change of firm website address, email address, physical location, or other such contact, biographical or geographical information. Other reasonable business purposes including but not limited to: appointment reminders, holiday mailings, birthday greetings and other informational mailings. The tax information may not be disclosed or used by FINANCIAL FREEDOM CONSULTANTS, its owner, employees, or staff, for any purpose other than that which is permitted by this consent document. If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484 by email at complaints@tigta.treas.gov.

Taxpayer Signature*

CONSENT FOR PAYMENT

Here at FINANCIAL FREEDOM CONSULTANTS, LLC it is our goal to provide you with an excellent experience. We thrive to get you the max refund that you qualify for. You as a taxpayer have the choice to pay your tax preparation fees by one of the following: cash, check, money order, credit card, or directly from your refund*.In the event that your refund is taken due to child support, student loans or wage garnishments your fee is still due. By signing your return you are agreeing to pay the preparation fees regardless if your refund was received or not. After 60 days from the date the refund was scheduled to arrive if no payment or payment arrangement is made, we will be forced to put your account into collections. Please stay in communication with us so that we can work with you if you need a payment arrangement.

Taxpayer Signature*

By signing, you are indicating you agree with the above consent for payment terms and conditions.