Client Intake Form 2021

  • 2024 CLIENT INTAKE FORM

    PLEASE FILL OUT ALL INFORMATION APPLICABLE
  • Date of Birth*
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  • Format: (000) 000-0000.
  • Date of Birth
     - -
  • Format: (000) 000-0000.
  • Filing Status:*
  • HEAD OF HOUSEHOLD FILERS MUST PRESENT ONE OF THE FOLLOWING TO FILE THIS STATUS. PICK ONE OF THE 3 OPTIONS THAT YOU WILL SUBMIT TO BE APPROVED TO FILE HEAD OF HOUSEHOLD.
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  • Dependent Information

    Please enter required dependent information based on the number of dependents selected. If additional aren't enough spots, included Social Security card in uploads and our office will contact you if necessary for additional information.
  • Date of Birth
     - -
  • Date of Birth
     - -
  • Date of Birth
     - -
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  • IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NOBODY ELSE IS ELIGIBLE TO CLAIM YOUR DEPENDENT BUT YOURSELF.

  • Did you pay someone to watch your child/children?

  • Health Insurance

  • Did you have health insurance in 2022?*
  • If yes, did you receive a 1095-A Form from the marketplace?

  • 2023 Income Information

    Answer the questions below regarding all income during the 2023 year
  • Did you have income from a W2(s)?*
  • Do you have any other income than your W2(s)?*
  • If you are self-employed, do you have the income and expenses gathered and organized in a professional document?
  • If your self-employed documentation is not professionally prepared, pleas select an option below:
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  • Did you make college tuition payments and received a 1098-T Form last year?*
  • Did you collect social security or retirement income?
  • Do you owe any delinquent:*
  • How would you like to receive your refund?*
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  • I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing Rooted Business Solutions to prepare my taxes based on that fact. I understand that I am financially responsible for any outstanding balance due to any false information given.

    If there is a balance due, you must pay the tax preparation fee upfront. If for any reason you owe an entity and they take the entire refund, you are STILL responsible to pay the tax preparation fee for services rendered. 

    *For any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $150.00 is required! Please view your tax return, which is emailed to you (it is sent prior to submission). Any copy after the first copy is a fee of $10.00.

     ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS TO THIS!!

    Please utilize www.irs.gov for all federal refund tracking.  Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions. 

    For any direct assistance please email rootedbizsoultions@gmail.com

    IRS Contact 800-829-1040

     

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