365 TAX CLIENT INTAKE FORM

1
DATE* This field is required.
Date
Month
Day
Year
2
WHAT (TAX YEAR) DOES THIS CLIENT INTAKE FORM PERTAIN TO?* This field is required.
2024
2023
2022
2021
2020
2019
Other
3
TAXPAYER FULL NAME* This field is required.
First Name
Last Name
4
ARE YOU FILING JOINTLY WITH A SPOUSE?* This field is required.
YES
NO
5
SPOUSE FULL NAME
6
UPLOAD TAXPAYER SOCIAL SECURITY CARD* This field is required.
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7
UPLOAD SPOUSE SOCIAL SECURITY CARD
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8
WHICH AGENT WILL BE ASSISTING YOU WITH YOUR TAX PREPARATION THIS YEAR* This field is required.
Please Select
Please Select
DERRICK ROBINSON
MARGARET PEGUES
HIEDI GADSON
SELECT A TAX PROFESSIONAL FROM THE DROPDOWN LIST
9
WHO INFORMED YOU OF OUR SERVICES?
10
DID YOU FILE A TAX RETURN LAST YEAR?* This field is required.
YES
NO
11
WHAT IS THE NAME OF THE TAX PREPARATION COMPANY THAT ASSISTED YOU LAST YEAR?
12
WHAT IS THE NAME OF THE TAX PREPARER THAT ASSISTED YOU LAST YEAR?
13
PLEASE UPLOAD YOUR MOST RECENT TAX RETURN FOR IDENTITY VERIFICATION PURPOSES (FORM 1040)
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Max. file size: 10.6MB
NEW CLIENT ONLY
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14
ARE YOU AMENDING A PRIOR YEAR RETURN WITH US?* This field is required.
YES
NO
I DID NOT FILE LAST YEAR
15
PLEASE UPLOAD THE PREVIOUS RETURN YOU WOULD LIKE TO BE AMENDED (FORM 1040)
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16
MAILING ADDRESS
17
MAILING ADDRESS* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
18
CITY
19
STATE
20
ZIP CODE
21
TAXPAYER EMAIL ADDRESS* This field is required.
example@example.com
22
SPOUSE EMAIL ADDRESS
example@example.com
23
TAXPAYER MOBILE PHONE* This field is required.
24
SPOUSE MOBILE NUMBER
25
TAXPAYER DATE OF BIRTH* This field is required.
Date
Month
Day
Year
26
SPOUSE DATE OF BIRTH
Date
Month
Day
Year
27
TAXPAYER OCCUPATION/PROFESSION* This field is required.
28
SPOUSE OCCUPATION/PROFESSION
29
DID YOUR ADDRESS CHANGE SINCE LAST YEAR TAX RETURN?* This field is required.
YES
NO
30
WERE YOU COVERED BY A HEALTH INSURANCE PLAN AT ANYTIME LAST YEAR* This field is required.
YES
NO
I DON'T KNOW
31
IF YOU WERE COVERED BY AN HEALTH INSURANCE PLAN AT ANYTIME LAST YEAR, WHAT WAS THE NAME OF THE INSURANCE COMPANY?
32
DID YOU COLLECT HEALTH INSURANCE THROUGH THE HEALTH INSURANCE MARKETPLACE AND RECEIVED FORM (1095-A)?* This field is required.(PLEASE CALL 1-800-318-2596 TO VERIFY IF UNSURE BEFORE MOVING FORWARD)
YES
NO
I DON'T KNOW
33
PLEASE UPLOAD FORM (1095-A) TO REPORT ADVANCE PAYMENTS OF PREMIUM TAX CREDIT
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34
WHAT IS YOUR FILING STATUS?* This field is required.
SINGLE
HEAD OF HOUSEHOLD
MARRIED FILING JOINTLY
MARRIED FILING SEPARATELY
QUALIFYING(WIDOW)ER WITH DEPENDENT
35
DO YOU CARRY AN OUTSTANDING BALANCE WITH THE IRS AT THIS TIME?* This field is required.
YES
NO
36
DO YOU WANT THE FEES ASSOCIATED WITH YOUR TAX PREPARATION TO BE DEDUCTED FROM YOUR TAX REFUND?* This field is required.IF YOUR ANSWER IS "NO" YOUR TAX PREPARATION FEE WILL BE SEPARATELY INVOICED AND DUE PRIOR TO TAX FILE SUBMISSION TO THE IRS
YES
NO
37
HOW WOULD YOU LIKE TO RECEIVE YOUR TAX REFUND?* This field is required.WE HAVE MULTIPLE OPTIONS TO GET YOUR MONEY FAST AND EASY
CASHIERS CHECK
DIRECT DEPOSIT
PREPAID CARD
38
ARE YOU APPLYING FOR A REFUND ADVANCE UP TO $6,000? (NO LONGER AVAILABLE AFTER FEB 28th)* This field is required.
YES
NO
39
BANK ROUTING NUMBERFOR DIRECT DEPOSIT OF TAX REFUND
FOR DIRECT DEPOSIT OF REFUND
40
BANK ACCOUNT NUMBER FOR DIRECT DEPOSIT OF TAX REFUND
FOR DIRECT DEPOSIT OF REFUND
41
TAXPAYER DRIVERS LICENSE* This field is required.FOR IDENTITY VERIFICATION PURPOSES
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Max. file size: 10.6MB
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42
HAVE YOU BEEN ISSUED AN IDENTITY PROTECTION PIN FROM THE IRS* This field is required.FORM CP10A
YES
NO
43
PLEASE UPLOAD YOUR CP01A NOTICE FROM THE IRS FOR IDENTITY PROTECTION
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44
DO YOU HAVE QUALIFYING DEPENDENTS AGES 17 OR YOUNGER?* This field is required.TAX CREDIT VERIFICATION
YES
NO
45
HOW MANY DEPENDENT(S) ARE YOU CLAIMING ON THIS TAX RETURN?
46
HOW MANY MONTHS DID THE DEPENDENT(S) LIVE WITH YOU DURING THE YEAR?
47
DO YOU HAVE QUALIFYING DEPENDENTS WITH A DISABILITY?* This field is required.
YES
NO
48
DEPENDENT SOCIAL SECURITY OR BIRTH CERTIFICATE
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49
DEPENDENT #1 SOCIAL SECURITY NUMBER
50
QUALIFYING DEPENDENT DATE OF BIRTH?
Date
Month
Day
Year
51
DEPENDENT RELATIONSHIP TO TAXPAYER?
SON
DAUGHTER
BROTHER
SISTER
NEPHEW
NEICE
MOTHER
FATHER
HALF BROTHER
HALF SISTER
STEPCHILD
STEPBROTHER
STEPSISTER
ADOPTED CHILD
GRANDCHILD
OTHER
52
DEPENDENT SOCIAL SECURITY OR BIRTH CERTIFICATE
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53
DEPENDENT #2 SOCIAL SECURITY NUMBER
54
QUALIFYING DEPENDENT DATE OF BIRTH?
Date
Month
Day
Year
55
DEPENDENT RELATIONSHIP TO TAXPAYER?
SON
DAUGHTER
BROTHER
SISTER
NEPHEW
NEICE
MOTHER
FATHER
HALF BROTHER
HALF SISTER
STEPCHILD
STEPBROTHER
STEPSISTER
ADOPTED CHILD
GRANDCHILD
OTHER
56
DEPENDENT SOCIAL SECURITY OR BIRTH CERTIFICATE
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Max. file size: 10.6MB
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57
DEPENDENT #3 SOCIAL SECURITY NUMBER
58
QUALIFYING DEPENDENT DATE OF BIRTH?
Date
Month
Day
Year
59
DEPENDENT RELATIONSHIP TO TAXPAYER?
SON
DAUGHTER
BROTHER
SISTER
NEPHEW
NEICE
MOTHER
FATHER
HALF BROTHER
HALF SISTER
STEPCHILD
STEPBROTHER
STEPSISTER
ADOPTED CHILD
GRANDCHILD
OTHER
60
DEPENDENT SOCIAL SECURITY OR BIRTH CERTIFICATE
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Max. file size: 10.6MB
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61
DEPENDENT #4 SOCIAL SECURITY NUMBER
62
QUALIFYING DEPENDENT DATE OF BIRTH?
Date
Month
Day
Year
63
DEPENDENT RELATIONSHIP TO TAXPAYER?
SON
DAUGHTER
BROTHER
SISTER
NEPHEW
NEICE
MOTHER
FATHER
HALF BROTHER
HALF SISTER
STEPCHILD
STEPBROTHER
STEPSISTER
ADOPTED CHILD
GRANDCHILD
OTHER
64
DEPENDENT SOCIAL SECURITY OR BIRTH CERTIFICATE
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Max. file size: 10.6MB
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65
DEPENDENT #5 SOCIAL SECURITY NUMBER
66
QUALIFYING DEPENDENT DATE OF BIRTH?
Date
Month
Day
Year
67
DEPENDENT RELATIONSHIP TO TAXPAYER?
SON
DAUGHTER
BROTHER
SISTER
NEPHEW
NEICE
MOTHER
FATHER
HALF BROTHER
HALF SISTER
STEPCHILD
STEPBROTHER
STEPSISTER
ADOPTED CHILD
GRANDCHILD
OTHER
68
DID YOU PROVIDE MORE THAN 50% OF THE FINANCIAL SUPPORT FOR THE DEPENDENTS YOU HAVE CLAIMED* This field is required.TAX CREDIT VERIFICATION
YES
NO
I HAVE NO DEPENDENTS
69
DID YOU PAY ANY CHILD OR DEPENDENT CARE EXPENSES TO SOMEONE OR A DAYCARE PROVIDER LAST YEAR?* This field is required.TAX CREDIT VERIFICATION
YES
NO
70
PLEASE UPLOAD FORM RECEIPT FROM DEPENDENT CARE PROVIDER TO REPORT ELIGIBLE EXPENSES
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71
DO YOU HAVE A W-2 TO FILE?* This field is required.
YES
NO
72
HOW MANY W-2's DO YOU HAVE?* This field is required.
IF MORE THAN TWO W-2'S PLEASE BE SURE TO PROVIDE PREPARER WITH ALL COPIES
73
PLEASE UPLOAD FORM W-2
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74
PLEASE UPLOAD 2ND FORM W-2
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75
PLEASE UPLOAD 3RD FORM W-2
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76
PLEASE UPLOAD 4TH FORM W-2
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77
DO YOU OWN A BUSINESS, WORK AS A INDEPENDENT CONTRACTOR OR PARTICIPATE IN GIG ECONOMY WORK?* This field is required.SCHEDULE-C TAX FILE NEEDED
YES
NO
78
IF YOU ARE AN INDEPENDENT CONTRACTOR PLEASE UPLOAD FORM (1099-NEC) OR (1099-MISC)FOR PREPARATION OF SCHEDULE-C
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79
DID YOU RECEIVE UNEMPLOYMENT INCOME LAST YEAR?* This field is required.
YES
NO
80
PLEASE UPLOAD FORM (1099-G) TO REPORT UNEMPLOYMENT INCOME
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81
WERE YOU STUDENT AT A COLLEGE, UNIVERSITY OR OTHER EDUCATIONAL INSTITUTIONS LAST YEAR?* This field is required.
YES
NO
82
WERE YOU PART TIME OR FULL TIME STUDENT?* This field is required.
PART-TIME
FULL-TIME
NOT A STUDENT
83
PLEASE UPLOAD FORM (1098-T) TO REPORT QUALIFIED TUITION EXPENSES
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Max. file size: 10.6MB
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84
PLEASE UPLOAD FORM (1098-E) TO REPORT STUDENT LOAN INTEREST PAID
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85
ARE YOU ITEMIZING YOUR DEDUCTIONS FROM LAST YEAR ON THIS TAX RETURN?* This field is required.
YES
NO
86
ARE YOU A HOMEOWNER?* This field is required.
YES
NO
87
PLEASE UPLOAD RECEIPT TO REPORT PROPERTY TAXES PAID
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88
DID YOU RECEIVE INCOME OR MAKE A WITHDRAWAL FROM YOUR (401K), PENSIONS, ANNUITIES, OR IRA ACCOUNTS ETC..?* This field is required.
YES
NO
89
PLEASE UPLOAD FORM (1099-R) TO REPORT RETIREMENT BENEFITS RECEIVED
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Max. file size: 10.6MB
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90
PLEASE UPLOAD TAX DOCUMENT FOR YOUR RETIREMENT or SAVINGS ACCOUNT SUCH AS (HSA, 401k, 403b, 457 plan, Simple IRS, SEP IRA)
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Max. file size: 10.6MB
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91
SELECT ALL DOCUMENTS THAT YOU HAVE PROVIDED OR WILL PROVIDE TO YOUR TAX PREPARER (SELECT ALL THAT APPLIES TO YOU)* This field is required.
92
SIGNATURE REQUIRED* This field is required.
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