Financial Client Intake Form

Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Alternative Phone Number
Please enter a valid phone number.
Did someone refer you? Type their name or type "no"*
Tax Payers Date of Birth*
Tax Payers Social Security Number*
How many W2's Does The Tax Payer Have?
Bank Information ( We only do direct deposit)
Name of Bank*
Routing Number*
Bank Account Number*
Spouse's Full Name
Spouse's Phone Number
Spouse's Date of Birth
Spouse's Social Security Number
How many W2's Does Your Spouse have?
Spouse's Email Address
Preferred Method of Contact
Do you own a business and/or were you self employed?

YesNo
What Type of Self Employed Work?
How much profit was made in 2023 for your business?
Do you certify the profit made in 2023 is true, accurate and is given to use as a source of income for your 2023 Federal and State return?

YesNoN/A
Did you incur material expenses to operate your business in 2023?

YesNoN/A
How many dependents are you claiming?

OneTwoThreeFourFiveSixSevenOther
Dependent #1 Full Name
Dependent # 1 Date of Birth
Dependent # 1 Social Security Number
What is the relationship to dependent # 1?
How many months did dependent #1 live with you in 2023?
Dependent # 2 Full Name
Dependent # 2 Date of Birth
Dependent # 2 Social Security Number
What is the relationship to dependent # 2?
How many months did dependent # 2 live with you in 2023?
Dependent # 3 Full Name
Dependent # 3 Date of Birth
Dependent # 3 Social Security number
What is the relationship to dependent # 3?
How many months did dependent # 3 live with you in 2023?
Are there any dependents in daycare? If so, please upload the form you receive from the daycare provider.
If you had insurance through the marketplace, did you receive a 1095A Health Insurance Marketplace statement? (Not providing form IRS could delay your refund)
Have you ever been denied the Earned Income Tax Credit (EITC)?

YesNo
Did you or spouse attend college in 2023?

YesNo
Did any of your dependents attend college in 2023?

YesNoN/a
Do you have a Form 1098T (Tuition Statement) for either you, your spouse and/or dependents?

YesNo
Select proof of business you have today?*

Business EinBank StatementBusiness Card or FlyerProof of expensesN/A
All IRS prescribed forms. (Example W2, 1099 misc, 1099 INT....) Proof of dependents. (SSC, Birth Certificate, Shot records) Your ID. FYI if you are returning client I will only need updated documents as long as ID is not expired on file.

Cancelof
Please check and confirm all numbers including social security numbers, bank account information before submitting. Please check and confirm all names are spelled correctly and all information is correct. All files can be emailed to kwanshepard.minoritytaxpros@gmail.com

Phone:(903) 244-3893
I confirm and agree that all information is correct.

I agree
I am giving Zakwandria Shepard Agent of Minority Tax Pros 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 understand that Zakwandria Shepard of Minority Tax Pros holds no responsibility for any misrepresentation or false claims.

I agree
Tax Payer Signature

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Spouse’s Signature

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