Form 1040 - Individual Income Tax Return Form

Client Intake Form

Welcome to Exclusive Tax & Notary. Please complete this form to provide us with the accurate information to best serve you. If you have any additional questions or concerns, please email Infoexclusivetax@gmail.com We are looking forward to serving you! PLEASE ALLOW ATLEAST 24 HOURS FOR YOUR RETURN TO BE COMPLETED.
ENGAGEMENT LETTER

Dear Exclusive Tax Client,

We are pleased to provide tax services to you. This engagement letter outlines the terms and scope of our services. Exclusive Tax & Notary will prepare your 2025 individual/business tax return, including federal and state income tax returns, local tax returns (if applicable) and other related tax forms and schedules. You agree to provide accurate and complete information, furnish necessary documents at the time of filing. Please review and sign the return. We will prepare accurate and complete tax returns, conduct thorough reviews and ensure timely filing. Our starting rate is $349.95 and goes up based on the complexity of the return,(Exclusive Tax & Notary charge per form we have to work) We have a pay by refund option meaning you pay nothing out of pocket (only applies if your owed a refund). Additional services, such as audit representation and tax planning, will be billed separately and must be paid upfront. We maintain confidentiality of all client information. if you complete the jotform and decide you dont want to continue and the work is done you will be responsible to pay a $25 fee for the work that was completed. By signing the intake form, you acknowledge receipt and acceptance of these terms.

Sincerely,
Exclusive Tax Management
PLEASE ANSWER 0NLY THE QUESTIONS THAT APPLY TO YOU
How did you hear about Exclusive Tax & Notary? (Ex: Facebook, A friend)*
Who referred you? (List Name of person)*
Are you a....*

Returning Tax ClientNew Tax Client
New Clients Only Please upload Last Years Tax Return or Transcript.

Cancelof
Filling Status*

Single (S)Married Filing jointly (MFJ)Married Filing Separately (MFS)Head Of Household (HOH)Qualifying Surviving Spouse (QSS)
Did you pay over half the expenses of maintaining your residence for the entire year?*

YesNo
Taxpayer Name*

First NameLast Name
Spouse Name

First NameLast Name
Taxpayer occupation*
Spouse's occupation
Taxpayer social security number*
Spouse's social security number
Taxpayer Phone Number*
Please enter a valid phone number.
Spouse's Phone Number
Please enter a valid phone number.
Taxpayer IP (PIN)
Spouse's IP (PIN)
Email Address You Want on File *
Address*

Street Address

Apt. No.

CityState / Province

Postal / Zip Code
Are you applying for a Refund Advance? (loan)*

YesNo
Did you receive a Refund Advance Loan last year?*

YesNo
Would you like to opt-in the fast forward program to receive your refund 5 days sooner? (Please note it is a $25 fee that will be included in your bank fee)*

YesNo
Did you receive your taxes from last year?*

YesNoI'm Still Waiting to get paid
UPLOAD A CLEAR PHOTO OF YOUR Valid ID, DL, And Social Card*

Cancelof
Presidential Election Campaign: Check here if you, or your spouse is filling jointly, want $3 to go to this fund. Checking a box below will not change your tax or refund.

YouSpouseNo
At any time during 2025, did you receive, sell, send, exchange, or otherwise acquire any financial interest in any virtual currency?

YesNo
Someone can claim:*

You as a dependentYour spouse as a dependentSpouse itemizes on a separate return or you were a dual-status alienNone apply to me.
You:

Were born before January 2, 1956Are blindNo
Spouse:

Were born before January 2, 1956Is blindNo
Did you receive Marketplace Insurance?*

YesNO
Please upload a clear Photo of your 1095A Form

Cancelof
College

1098 T Form
Did you attend college in 2025?*

YesNo
Have you caught any drug related charges while attending college?*

YesNo
If yes, please explain charges below
Upload a clear photo of your 1098 T Form

Cancelof
Dependents
Did you support a child or family member for more than 6 months out of the year?*

YesNo
Did the dependent(s) have Medicaid the entire year?*

YesNo
Did the child receive Food Stamps or Wic in 2025?*

YesNo
Have you ever been disallowed the CTC OR EIC Credit in the past?*

YesNo
Do you have any dependents? If so, please fill out the chart below. (Attach all Information needed)*

YesNo
How many dependents do you have?*
Is the child enrolled in school under your address?*

YesNo
If no, please list the child's name below and the reason the child isn't enrolled under your address?

Please fill in your dependent information please scroll to the right to view the full chart.

Rows	First Name	Last Name	Social Security Number	Relationship to You	Child Tax Credit	Credit for Other Dependents	Date Of Birth	How many months did child live in your home?	IP PIN
1.
2.
3.
4.
5.
6.

If the dependent is not your biological child, why the parent isn't claiming the child?*
Upload a Clear Photo of all the children Birth Certificate and Social Cards.

Cancelof
Income Statements

w2 forms, 1099's
Do you have all your w2 forms,1099's all income statements? Please keep in mind that you must have all your income statements to avoid an audit.*

YesNo
Upload a Clear Photo of all your W2 Forms, 1099's or any income statements you have. If your self employed please upload some type of proof of income*

Cancelof
Do you understand that you will be audited if you miss any w2 forms, you also understand that you can be audited for unreported earnings and will owe the IRS? IF YOU NEED TO AMEND YOUR TAXES DUE TO UNREPORTED EARNINGS YOU WILL BE CHARGED $400.00 UPFRONT TO AMEND YOUR RETURN*
Did you receive unemployment in 2025? If yes, Upload the required document.*
Upload 1099 G Form

Cancelof
Self Employed Business
Do you own a business/ Self Employed?*

YesNo
What Kind of business did you operate?*
Do you have a EIN number for your business?*

YesNo
If yes, Enter EIN number
How much profit was made in 2025 for your business.?
Do you certify the profit made in 2025 is true, accurate and is given to use as a source of income for your 2025 federal and state return?

YesNo
Mortgage Interest Statement

1098 Form
Do you have a Mortgage Interest Statement? If so, please upload your interest Statement Form.*

YesNo
Upload a Clear Photo Of Your Mortgage Statement Form

Cancelof
Refund

Disbursement of refund
Refund Offset & Repayment Agreement If your federal or state tax refund is reduced, withheld, or taken due to an offset (such as past-due child support, student loans, state debts, or other government obligations), you agree that the full preparation fees remain due and payable. In the event that the refund is offset, the agreed-upon preparation fee will be automatically drafted from the account you have provided on file.

Yes I understand
Is the Bank Account in your name? (Please note if the account is not in your name your refund will be rejected and will be held up by the IRS.)*
Type of Account*

Checking's AccountSaving's AccountCheck (Printed inside Tax office)Go2 Bank Debit Card
What's the name of your Bank?*
Routing number
Account number
Upload a image of your Account and Routing Number.*

Cancelof
Tax Professional

Please choose your tax professional
Do you want to allow your tax professional to discuss your 2025 tax return with the IRS?*

YesNo
What's your tax professional name.? Please contact your tax professional if you have additional questions or if you need to Email any missing documents.*

Dr. Crystal (214)664-2376 (CEO)Kelvin (214)664-2376 (COO)NO ASSIGNED TAX PROFESSIONALPrecious (214)714-6708 (Team Lead)Audrey (469)758-9861DeDe(469)493-2155Kalah (214)283-6613Tranesia (945)306-1129LaQuesha (469)921-0342Sophia (469)739-6698Brittini (214)810-2089Shontie (972)589-0907Kaneshia (214)815-3237Bre (945) 354-4089
Please check and confirm all information including social security numbers, bank account information, dependent information is all correct before submitting. Please check and confirm all names are spelled correctly and all information is correct. Any missing Files you didnt submit please call your tax professional to submit additional files that wasnt uploaded. Your tax professional will provide you with their email to submit your information.
I confirm and agree i double checked all information for any errors*

YesNo
I give Exclusive Tax & Notary permission to prepare all forms related to my tax return and I have signed all necessary forms to file my income tax return electronically. I take full responsibility for the accuracy of this client intake form and I understand that Exclusive Tax & Notary holds no responsibility for any misrepresentation or false claims.*

I fully Agree, everthing is accurate information with no false documents
Sign Here

Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Your Signature*
Spouse's Signature
Date*

MonthDayYear
Date
Date

MonthDayYear
Date
Was the virtual intake form easy to complete?*
Should be Empty:

Client Intake Form

PLEASE ANSWER 0NLY THE QUESTIONS THAT APPLY TO YOU

College

Dependents

Income Statements

Self Employed Business

Mortgage Interest Statement

Refund

Tax Professional

Sign Here