Upscale Business Solutions Intake Form

Name Of Tax Preparer you are requesting.
Full Name

First NameLast Name
Did anyone refer you?

First NameLast Name
Phone Number
Format: (000) 000-0000.
Who is your cell phone carrier?
Verizon, T-mobile, etc.
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number
Format: (000-00-0000.
Date of Birth
Have you recently filed Bankruptcy?
If so, when?
Do you have student loans?
Do you owe any other federal agencies?
Child support, Unpaid taxes, student loans, etc.
What is your occupation?
What is your filing status
Spouse Name

First NameLast Name
Spouse Social Security Number
Format: (000-00-0000.
Spouse Date of Birth
Do you have dependents?
Do you or any of your dependents have an identity theft pin?
What was your income this year?
Did you receive payments from Zelle, Cash App, Venmo, Paypal, etc?
Was your income less than 20k?
Are you only self employed?
Dependent 1: NAME

First NameLast Name
Dependent 1 DOB:

MonthDayYear
DOB
Dependent 1 Social Security Number
Please enter dependent Social security numberFormat: (000-00-0000.
Dependent 2: NAME

First NameLast Name
Dependent 2 Social Security Number
Please enter dependent Social security numberFormat: (000-00-0000.
Dependent 2 DOB:

MonthDayYear
DOB
Dependent 3: NAME

First NameLast Name
Dependent 3 Social Security Number
Please enter dependent Social security numberFormat: (000-00-0000.
Dependent 3 DOB:

MonthDayYear
DOB
Can anyone else claim these dependents?
Account to receive refund?

Bank Name

Routing

Account Number

Routing number
Confirm Account Information

Bank Name

Routing

Account Number

Routing number
Are you planning to purchase a home within the next 2-3 years?
Please upload all documents

Driver's License, Birth certificates, W2s, Self employment, Social Security Cards, Utility Bill
Cancelof
Signature
I would like to inform that the above mentioned individual approached our agency personally and submitted documents which I believe are genuine as he has proved to be the person mentioned in the id.
Should be Empty: