Client Intake Form & Appointment Request

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

Returning ClientNew

Tax Year

Did some refer you??

Filing Status:*

Date of Birth*

MonthDayYear

Social Security Number*

Phoner Number*

Please enter a valid phone number.

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.

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?

YESNO

Did you collect social security or retirement income?

YESNO

Did you purchase health insurance through healthcare.gov marketplace (Obama Care) (If YES; Attached document)*

YesNo

If yes, did you receive a 1095-A Form from the marketplace?

YesNo

Were you ever disallowed the E.I.T.C prior to this year?*

YesNo

Did you receive unemployment compensation (1099-G) regular or PUA last year? (If YES, Please ATTACH Document)*

YESNO

If yes, did you receive regular unemployment or PUA?

RegularPUA

Did you make college tuition payments and received a 1098-T Form last year? (If YES, ATTACH Document)*

YESNO

Do you have any other income than your w-2(s)?*

YESNO

Do you owe any delinquent:*

Elaine Yvette Client INTAKE FORM