NEW CLIENT INTAKE FORM

PRESTON THOMPSON TAX SERVICE

NEW INTAKE FORM

WWW.PRESTONTHOMPSONTAXSERVICE.COM

ADMIN@PRESTONTHOMPSONTAXSERVICE.COM

(470) 369-0439
TODAY'S DATE*

MonthDayYear
PRIMARY FULL NAME*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Social Security Number*
Phone Number*

Area CodePhone Number
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does your address differ from the State return you filed last year?**

YESNO
IF YOUR ADDRESS HAS CHANGE PLEASE UPDATE BELOW.
Address

Street Address

Street Address Line 2

CityState

Zip Code
What county do you live in?*
Did Anyone Receive Unemployment?*
Did Anyone of Health Care from the Market place?*

YESNO
Were there any children added to the family or are you not filing a child this year? Any additional dependents add here.
Please state name, date of birth, social of each dependent.
Do your dependents reside in the home with you? *
Dependent's Full Name*

First NameLast Name
Dependent's date of birth:

MonthDayYear
Date
Dependent's Social Security number*
Primary Drivers License #*
Primary Drivers license Issue Date*

MonthDayYear
Date
Primary Drivers license Experation Date*

MonthDayYear
Date
Spouses Drivers License
Spouse Drivers License Issued Date

MonthDayYear
Date
Spouse Drivers License Experation Date

MonthDayYear
Date
How do you want your refund or if you owe click on the OWE option?*

DIRECT DEPOSITCHECKVISA PREPAID CARDOWE
Bank Name*
Direct Deposit Info: Checking Account Number*
Direct Deposit Info: Routing Number*
what was your prior year AGI?*
Are you Interested in any of the following?
FAST CASH ADVANCE Processing Fee ($125.00 Pre-Ack) Check($25.00 Post-Ack) Prepaid Card One Time Payment is Non-Refundable.*

No-Not InterestedYes-Interested and would like to pay for this out of my current year Refund
Audit Protection $68.95 (one time payment)*

No-Not InterestedYes-Interested and would like to pay for this out of my current Refund.
Important Note about the FAST CASH: This is a loan against your refund. If you apply for anything over $500 and you get approved. Their is an additional 36% interest on your loan. (not recommended). Anything under $500 the processing fee applies (see above).
Your Tax Preparer's Name & Email is Required So They Will Receive a Copy of This Form. Call them after to confirm they received it and IF NOT, forward them the copy that will be emailed to you.*

First NameLast Name
Tax Preparer's Email*
example@example.com
Is there any other info you want your tax preparer to know? ex: additional dependents*

MAKE $75 FOR EACH TWO REFRENCES THAT YOU REFER AND FILE THEIR TAXES! :*

Rows	Full Name	Address	Contact Number
1
2

How did you hear about us?*
who referred you?*
This form is a semi-duplicate of your intake form from last year. Click below & sign to indicate that this form is your express permission for your tax professional to prepare and submit your tax return. EXIT OUT and do not sign this form if you are not giving the preparer permission to do your taxes.
Print Full Name*

First NameMiddle NameLast Name
Signature*
Should be Empty: