Tax Intake Form

How did you hear about us?

Tax Payers Name

First NameLast Name

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

Taxpayer's Phone Number

Example: xxx-xxx-xxxx

Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Taxpayer's Driver's License

Browse Files

Taxpayer's Social Security Card(s)

Browse Files

Taxpayer's Date of Birth

Example: 01/01/2001

Taxpayer's SSN

Example: xxx-xx-xxxx

Taxpayer's Email Address

Spouse's Full Name

First Name

Spouse's SSN

Example: xxx-xx-xxxx

Spouse's Date of Birth

Example: 01/01/2001

Spouse's Phone Number

Example: xxx-xxx-xxxx

Spouse's Email Address

Example: example@example.com

Are you self employed?

Taxpayer's W-2/ 1099'S

Browse Files

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

How many dependents are you claiming?

Dependent(s ) Social Security Card(s)

Browse Files

Dependent(s) Birth Certificate(s)

Browse Files

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.)?

Dependent #2

First NameLast Name

Dependent #2 Date of Birth

Example: 01/01/2001

Dependent #2 SSN

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

Dependent's #3 SSN

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

Dependent #4

First NameLast 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.)?

Dependent #5

First NameLast 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.)?

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.

Browse Files

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

Other

Routing Number

Bank Account Number

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

If you have a 1095-A form, upload it here.

Browse Files

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

Browse Files

Are you interested in AUDIT PROTECTION?

Are you interested in Financial Coaching?

CLIENT NON PAYMENT/OFFSET CLAUSE

At WiseSource Alliance, we strive to assist all of our clients in their tax needs, however we understand that situations arise. If your refund is offset by the IRS, student loans, child support or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return.

I am giving WiseSource Alliance permission to prepare all forms related to my tax return; to file on my behalf; and file my taxes electronically. I take full responsibility for the accuracy of this form and understand that WiseSource Alliance and/or associated affiliates hold no responsibility for any misrepresentation or false claims.

ADDITIONAL SERVICES

At WiseSource Alliance, we do more than just taxes. Please comment below if you would be interested in any of the additional services we provide. We will schedule a time to speak with you at a later time.

Type a question

Date

Primary Taxpayer's Signature

Appointment

CLIENT FORM