Client Intake Form & Appointment Request

Elaine Yvette Client INTAKE FORM

Thanks for Choosing Elaine Yvette Tax Services: please read & complete this form to its entirety to ensure that everything is properly communicated and understood
I, hereby, state that all the information below is true to the best of my knowledge and that I am allowing Elaine Yvette Tax Service to prepare my taxes based on that fact. I understand that I am financially responsible for any outstanding balance due to any false information given.

ALL FEES (bank and service fees) are calculated by the system; you will be provided this information prior to processing the return and are non-refundable nor negotiable!

NO EXCEPTIONS TO THIS!!

If there is a balance due, YOU must pay the tax preparation fee upfront (you can be invoiced). Your RETURN will NOT be PROCESSED until balance is PAID IN FULL. If for any reason YOU owe an entity and they take my entire refund, YOU are STILL responsible to pay the tax preparation fee for services rendered.

*For any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $200.0 is required! Please view your tax return, which will be emailed to you .

Any hardcopy requested after the initial copy provided a fee of $20.00 will be required

For any direct assistance please text (803) 605-2219 or email ElaineYvetteEnterprise@Gmail.com
Client Type
Tax Year
Did some refer you??
Filing Status:
Date of Birth

MonthDayYear
Social Security Number
Phoner Number
Please enter a valid phone number.Format: (000) 000-0000.
Taxpayer Name

First NameLast NameSuffix
Email Address
example@example.com
Occupation
Address

NO P O BOX/ PHYSICAL ADDRESS ONLY

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Information

First NameLast NameSuffix
Date of Birth

MonthDayYear
Social Security # (XXX-XX-XXXX)
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Occupation
Number Of Dependents
Dependent 1

First NameLast NameSuffix
Relationship
Date of Birth

MonthDayYear
Social Security Number
Dependent 2

First NameLast NameSuffix
Relationship
Social Security Number
Date of Birth

MonthDayYear
Dependent 3

First NameLast NameSuffix
Relationship
Date of Birth

MonthDayYear
Social Security Number
IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NOBODY ELSE IS ELIGIBLE TO CLAIM YOUR DEPENDENT BUT YOURSELF.
If claiming son/daughter, where is the other parent of the dependent/dependents? Is the other parent providing any financial support?
If claiming niece, nephew, aunt, or uncle, how are you related to the dependent? Where are the parents to the dependent/dependents?
If claiming brother or sister, how are you related to the dependent? Why are the parents not claiming the dependent/dependents?
Did you pay someone to watch your child/children?
Did you collect social security or retirement income?
Did you purchase health insurance through healthcare.gov marketplace (Obama Care) (If YES; Attached document)
If yes, did you receive a 1095-A Form from the marketplace?
Were you ever disallowed the E.I.T.C prior to this year?
Did you receive unemployment compensation (1099-G) regular or PUA last year? (If YES, Please ATTACH Document)
If yes, did you receive regular unemployment or PUA?
Did you make college tuition payments and received a 1098-T Form last year? (If YES, ATTACH Document)
Do you have any other income than your w-2(s)?
Do you owe any delinquent:

DONT Forget to Upload Documents!!

Cancelof
How would you like to receive your refund?

Bank Information

Rows	Name of Bank	Routing Number	Account Number
ENTER BANK DATA

Please utilize www.irs.gov for all federal refund tracking. Please utilze your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal, and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions.

IRS Contact 800-829-1040

Please click this link to check your federal refund status. You will need your filing status, social security number, and the total amount of the refund before fees

https://sa.www4.irs.gov/irfof/lang/en/irfofgetstatus.jsp
Signature
Appointment
Date

MonthDayYear
Should be Empty:

Elaine Yvette Client INTAKE FORM