Gwens Tax Client Intake Form

How did you hear about us?

Tax Preparer Name

If someone referred you, please type his or her name here.

Are you trying to buy a new home within the next 2 years?

Are you interested in Credit Repair

Taxpayer's Name

First NameLast Name

Taxpayer's Phone Number

Example: xxx-xxx-xxxx

Taxpayer's Job Title

Taxpayer's Date of Birth

Example: 01/01/2001

Taxpayer's SSN

Example: xxx-xx-xxxx

Taxpayer's Email Address

Spouse's Last Name

First Name

Spouse's First Name

Last Name

Spouse's SSN

Example: xxx-xx-xxxx

Name

Last Name

Spouse's Date of Birth

Example: 01/01/2001

Spouse's Email Address

Example: example@example.com

Spouse's Phone Number

Example: xxx-xxx-xxxx

Taxpayer's SSN

Example: xxx-xx-xxxx

Spouse's Job Title

Input Your Job Title

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you self employed?

Did you and your spouse live apart during the year?

What is your marital status as of December

Did you pay over half the expenses of maintaining your residence for the entire year?

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

If yes, did you live together at any time after June 30, 2024?

Are you on any Government Assistance

How many dependents are you claiming?

Dependent #1

First NameLast Name

Dependent #1 Date of Birth

01/01/2001

Dependent #1 SSN

What is Dependent #1's Relationship to you (son, daughter, etc.)?

How many months did Dependent #1 live with you in 2024? (If all year, enter 12)

Dependent #2

First NameLast Name

Dependent #2 Date of Birth

Example: 01/01/2001

Dependent #2 SSN

How many months did Dependent #2 live with you in 2024? (If all year, enter 12)

What is Dependent #2's Relationship to you (son, daughter, etc.)?

Dependent #3

First NameLast Name

Dependent #3's Date of Birth

01/01/2001

How many months did Dependent #3 live with you in 2024? (If all year, enter 12)

Dependent #3s SSN

Example: xxx-xx-xxxx

What is Dependent #3's Relationship to you (son, daughter, etc.)?

Dependent's #3 SSN

Dependent #4's First Name

First Name

Dependent #4's Last Name

Last Name

Dependent #4's Date of Birth

01/01/2001

Dependent #4's SSN

Example: xxx-xx-xxxx

What is Dependent #4's Relationship to you (son, daughter, etc.)?

How many months did Dependent #4 live with you in 2024? (If all year, enter 12)

Dependent #5's First Name

First Name

Dependent #5's Last Name

Last Name

Dependent #5's Date of Birth

01/01/2001

Dependent #5's SSN

Example: xxx-xx-xxxx

What is Dependent #5's Relationship to you (son, daughter, etc.)?

How many months did Dependent #5 live with you in 2024? (If all year, enter 12)

Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.

Upload a copy of your daycare form here.

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How would you like to receive your tax refund?

Name of Bank

Which type of account would you like your refund deposited into?

Other

Routing Number

Bank Account Number

Can someone else claim you as a dependent?

Did you have health insurance in 2024?

Did you have health insurance for the entire year?

Who was your insurance cover through in 2024?

Was your insurance through your employer?

Was YOUR DEPENDENTS' insurance through your employer?

Who was your Dependents insured with in 2024?

Upload Taxpayer & Dependent(s)Insurance Documents

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

Were you or any of your dependents in college in 2024?

Did you trade any Virtual Currency

Do you have a 1098-T Form for either you or your dependents?

If you have a 1098-T form, upload it here.

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Are you interested in AUDIT PROTECTION?

Primary Taxpayer's Signature

Date

Spouse's Signature (If no spouse, leave blank)

Taxpayer's Signature (If no spouse, leave blank)

Type a note

Date

Taxpayer's Driver's License

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Taxpayer's and Dependent(s ) Social Security Card(s)

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Taxpayer's W-2/ 1099'S

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Dependent(s) Birth Certificate(s)

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Proof of Residency (Lease/Utility Bill)

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CLIENT FORM