LuxTaxBrand Client Intake Form

Tax Preparation Client Intake Form
Thank you for completing your client intake form. Please take time gathering you, your spouse, and your dependent's documents before starting this form. The more information and documentation you provide ensures we are capturing the most accurate information to file your federal and state tax returns without any issues.

Please wait until you have received all documents to complete this form. If all docouments are not provided correctly, your return may have a delay.

Providing all requested information during intake allows us to research and maximize deductions or minimize your liabilities for the tax year.

Please be sure to click the “Submit” button at the bottom of the form. You will receive a confirmation email to confirm your submission.

This should take you approximately 30 minutes to complete.

This intake form is highly secure and all requested information is required by the IRS. Your information is securely transmitted and protected using SSL (Secured Socket Layer) which provides the same protective measures as banks and physician’s offices. Protecting your sensitive information is of high importance to our firm.

If you have additional documentation that you were not able to upload, please email them directly to Support@LuxTaxBrandCo.com
Select your tax professional. *
How did you hear about LuxTaxBrand & Co., LLC.?
Let us know how you heard about us! Be sure to mention your referral!
Who referred you? How did you hear about us?
Which tax year are you filing?*
If you are filing for multiple tax years, you must complete a separate intake form for each tax year
Interview Date*

MonthDayYear
Please select the date you are completing this form
Interview Setting*

VirtualIn-OfficeTranslator Used - Select if someone assisted you with this intake form
Filing Status

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower
Upload proof of head of household - Be sure that the document is a clear copy - To be eligible for Head of Household credit, please provide a lease agreement or a recent utility bill. You also have to have a dependent.

Ex: Lease, utility bill (water, electric), etc...
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Would you like to apply for the Refund Advance Loan? (Additional fees may apply)

YesNo

Spouse Information
Upload taxpayer's SPOUSE Driver's License or State ID - Be sure that the document is a clear copy

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Upload taxpayer's SPOUSE Social Security Card - Be sure that the document is a clear copy

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Self-Employed - Only complete this if you own your own business or you are in a partnership
Did you have self-employed information you would like to add?

YesNo
What is the name of your business?
What is your EIN?
Employer Identification Number
Legal Address of Business

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Email
example@example.com
Business Phone Number
Please enter a valid phone number.
What is your business entity?

Sole ProprietorLLC - Single MemberLLC - S CorpLLC - Multi - MemberC - CorpS - CorpNon profit
What was your gross income for the tax year?
How long have you owned your business?
What type of services do you offer?
How many clients do you have?
Did you receive payments from a 3rd party network such as Cash App, Paypal, Venmo, etc...

YesNo
If yes, how much did you receive?
Do you travel for business?

YesNo
How do you track your mileage?
Do you maintain separate banking accounts for personal and business transactions?

YesNo
Upload supporting business documents - Be sure that the document is a clear copy

Ex: Detailed summary of expenses, Business License & Registration, Taxpayer Summary of Income, Bank Statements, Reconstruction of income and expenses, etc...
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Upload 1099- K (If applicable)- Be sure that the document is a clear copy

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List your business expenses - How much did you spend on each of these items?

	Yearly Amount (USD)
Advertising (Ads, website, etc...)
Travel (Hotels, Air BNB, etc...)
Rent/Lease
Meals
Supplies
Taxes
Wages
License
Office Supplies
Labor
Equipment
Utilities
Commission
Insurance
Legal Fees
Repairs
Vehicle Mileage
Vehicle Maintenance
Miscellaneous

Dependent(s) Information
Do you have dependents to claim on your tax return?

YesNo

What proof of residency can you provide for the dependent(s) you are claiming to validate they lived in your home for 6 months or more?*
Upload proof of residency for dependent(s) - Be sure that the document is a clear copy*

Ex: Report cards, Doctor's records, lease with children's names, Child care provider records, employer statement, Placement agency statement, Social service records or statement, etc...
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Did anyone else provide support for this dependent(s)?

YesNo
If yes, who and what is their relationship to the dependent?
Does the other parent have any rights to file the dependents(s) listed?*

YesNo
What is the status of other biological parent?

ActiveNot ActiveDeceasedWhereabouts unknownOther
What city and state does the other parent live in?
Did you pay anyone daycare fees for your dependent(s) for the tax year?

YesNo
Upload dependent(s) Social Security Card(s) - Be sure that the document is a clear copy

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Upload dependent(s) Birth Certificate(s) - Be sure that the document is a clear copy

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Upload dependent(s) daycare form(s) - Be sure that the document is a clear copy

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Tax Related Questions for Due Diligence

Do you, your spouse, and/or your dependents have health insurance within 12 months last year? If yes, who covers for it?*

	Yes/No	Employer	Spouse Ins	Exchange/ Marketplace	Direct with Insurer	Medicare	Medicaid
Taxpayer
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

If anyone in your household had insurance though the marketplace, please upload the 1095 A. If you don't provide this, it could cause a delay in refunds - Be sure that the document is a clear copy

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Did you or any of your dependents attend college during the tax year?

YesNo
Do you receive subsidized housing or section 8?

YesNo
Do you participate in any government assistance programs? If so, which one(s)? Select all that apply

Food StampsTANFMedicaidMedicare
How much do you receive monthly in benefits for subsidized housing, section 8, and/or other government assistance programs?
Ex: $258 in food stamps and $1300 in subsidized housing benefits
Please upload supporting documents - Be sure that the document is a clear copy

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Do you have a 1098 mortgage interest statement?

YesNo
Please upload supporting documents - Be sure that the document is a clear copy

Cancelof
Did you receive a federal tax last year?

Yes ; email last tax return to your preparerNo
Are you interested in any of these services?

Credit RepairBusiness Formation ServicesStock Market Investments

Acknowledgment & Signature
Our goal at LuxTaxBrand & Co. is to assist all of our customers with their tax requirements. However, we recognize that unforeseen circumstances can occur. If your refund is withheld by the IRS for reasons such as child support, student loans, IRS offset, or your refund check is mailed, you are still obligated to pay LuxTaxBrand & Co., LLC. any and all fees associated with filing your tax refund.

By signing this agreement, you acknowledge:
- If payment is not made in full within 45 days, legal actions will be sought to resolve payment
- All information entered on the client intake form is accurate and true
- LuxTaxBrand & Co., LLC. is to capture my sensitive data like personal id, government id, social security number (SSN), and other information
- I have read the terms and conditions and privacy policy of LuxTaxBrand & Co., LLC.
- I have read and understood your responsibilities and our responsibilities in doing this tax return.
- I have contacted the IRS offset hotline to determine if I have an offset and have notified LuxTaxBrand & Co., LLC.
If you are receiving a refund, how would you like your funds to be disbursed?*

Direct DepositCheck - Pick up in officeCheck mailedDebit card issued through LuxTaxBrand (Refund issued up to 4 days earlier)Other
What type of an account is this?*

Checking AccountSavings Account
Please enter your banking information here - Please be sure to double check your numbers to prevent delay in funding
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

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I authorize LuxTaxBrand & Co., LLC. to handle all aspects of my tax return, including preparing the necessary forms, signing all required documents, and electronically filing my taxes. I acknowledge that I am solely responsible for the accuracy of the information provided in this form and understand that LuxTaxBrand & Co., LLC. and its affiliates are not liable for any misrepresentation or false claims.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

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Tax Preparation Client Intake Form