Tax Client Intake Form

Thank you for selecting Nationwide Tax Pros for your professional Personal and Business Tax Services. We genuinely value your trust and confidence in our services. Your business is of utmost importance to us, and we are dedicated to providing you with exceptional assistance in managing your tax obligations.

To ensure we tailor our services to meet your specific needs, we kindly request that you complete our client intake form provided below. Your input will enable us to better understand your requirements and handle your tax filing efficiently.

(We Provide Services in all 50 States)

Tax Pro: Shar Hudson
CLIENT INTAKE FORM
Taxpayer Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Date Of Birth*

MonthDayYear
Date
Social Security Number*
What year are you requesting to file?*
Whats your current occupation? *
Did you receive a W-2?*

YesNo
Did you or your spouse receive Unemployment Compensation? (Form 1099-G)*

YesNo
Did you or your spouse collect Social Security or Retirement Income?*

YesNo
Did you or your spouse take a early withdrawal from your retirement account? (Form 1099-R)*

YesNo
Did you pay more than half of the expenses at your residence for the entire year?*

YesNo
Did you have Health Insurance the entire year?*

YesNo
What is your filing status?*
Did you receive any of the forms listed below regarding your Health Insurance?

1095A (Marketplace or Obama Care)1095B (Employer)
What was your marital status at the end of the year?*

Single (Not Married)MarriedSeparatedDivorce
Spouse Full Name (If Applicable)

First NameLast Name
Spouse Date of Birth

MonthDayYear
Date
Spouse Social Security Number
Spouse Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Spouse Email
Did your Spouse receive a W-2?

YesNo
Do you or your spouse own a home?*

YesNo
Were you or your spouse First Time Home Buyers this year?*

YesNo
Will you claim any dependents whom lived with you or whom you supported for more then 6 months this year?*

YesNo
Have you ever been denied the Earned Income Tax Credit (EITC) ?*

YesNoN/A
Dependent #1 Full Name

First NameLast Name
Relationship to Taxpayer
Daughter, son, niece, nephew, etc.
Date of Birth

MonthDayYear
Date
Social Security Number
Dependent #2 Full Name

First NameLast Name
Relationship to Taxpayer
Daughter, son, niece, nephew, etc.
Date of Birth

MonthDayYear
Date
Social Security Number
Dependent #3 Full Name

First NameLast Name
Relationship to Taxpayer
Daughter, son, niece, nephew, etc.
Date of Birth

MonthDayYear
Date
Social Security Number
Can you or any dependents be claimed by anyone else?*

YesNoN/A
If yes, which dependent can be claimed by someone else?
Did you or your spouse pay any daycare expenses for any dependents this year?

YesNo
Which dependent did you pay daycare for? (If Applicable)
Did you receive any Child Tax Credit Advance Payments?

YesNo
How much did you receive total in Child Tax Credit Advance Payments?
BUSINESS OWNER/SELF-EMPLOYMENT
Did you or your spouse receive a 1099 Form?

YesNo
Did you or your spouse incur expenses for your business or self-employment?

YesNo
Did you, your spouse, or a dependent attend college this year?

YesNo
Who attended college? (if Applicable)
Did this person receive a 1098T (Student Statement) Form from the college or university they attended?

YesNo
Did you receive your Economic Stimulus payments? If so, which round did you receive?

Round 1Round 2Round 3None
Do you or your spouse owe any of the following?

Back TaxesChild SupportStudent LoansAlimonyNone
How would you like to pay for your Tax Services?

Payment deducted from my refundPay upfront for my services (Cash, Cash App, Zelle, Paypal, Apple Pay)
How will you like to receive your refund?

Direct DepositPrepaid CardCheck
Are you interested in the Cash Advance option?

YesNo
BANK INFORMATION
Name of Bank*
Type of Bank Account*

CheckingSavings
Bank Routing Number*
Bank Account Number*
Do you consent and opt-in to receive text messages regarding your tax return?*

YesNo
What is the name of your cell phone carrier?
How did you hear about us?*
If referred, please list the first and last name of the person who referred you.
Driver's License/ID

Taxpayer and spouse
Cancelof
Social Security Cards

Cards for taxpayer, spouse, and dependents
Cancelof
Birth Certificates

All dependents
Cancelof
Proof of Resident

Utility Bill, Lease Agreement, etc.
Cancelof
Income Forms

W2, 1099, Expense Report, Bank Statements, Receipts
Cancelof
1098T

College Tuition Form
Cancelof
Childcare Statement

Form 2441
Cancelof
Please take a few moments to review and make sure that all the information you have inputted is complete and accurate.
CLIENT NON-PAYMENT/OFFSET AGREEMENT At Nationwide Tax Pros, our utmost priority is to ensure an exceptional tax experience for all our clients. We understand that unforeseen circumstances may arise. In the event that your tax refund is offset due to reasons such as IRS obligations, student loans, child support, or if your check is delayed in mailing, you are still accountable for and required to settle all fees associated with the preparation of your tax return. By signing this agreement, you acknowledge and agree that failure to make full payment within 30 days will prompt our pursuit of legal actions to resolve the outstanding payment.I hereby grant Nationwide Tax Pros the authorization to prepare all necessary forms pertaining to my tax return. I affirm that the information provided in this Client Intake Form is accurate and complete to the best of my knowledge. I understand that Nationwide Tax Pros will not be held responsible for any inaccuracies or false claims made in the information provided.*

AgreeDisagree
Please type your full name below.*

First NameLast Name
Signature*
Should be Empty:

CLIENT INTAKE FORM

BUSINESS OWNER/SELF-EMPLOYMENT

BANK INFORMATION