HP Tax Professionals Client Intake Form
PLEASE ANSWER ALL QUESTION
Who Is Your Tax Preparer :
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Surviving Spouse
Taxpayer Information
Name
First Name
Last Name
Age
Social Security Number
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
SSN
Is this your first time opening a pre-tax account? (Are you a new client)
Yes
No
Are You A Victim of Identity Theft ? What Is Your Identity Protection PIN (IP PIN)
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Are you legally blind?
Yes
No
Spouse Information
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
SSN
Are You A Victim Of Idenity Theft? What Is Your Identity Protection Pin (IP PIN)
Are they a full-time student?
Yes
No
Are they totally and permanently disabled? (Please provide documentation)
Yes
No
Are they legally blind?
Yes
No
Are they your dependent?
Yes
No
Dependents
Enter your dependents here
Name
SSN
Date of Birth
Relationship
1
2
3
4
5
6
Does you, your spouse, and 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
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Tax Related Questions
Employment Status
Employed
Unemployed
Self-employed
Does your dependents have tuition expenses? Please provide Form 1098T
Yes
No
Do you have a business? if so what is the name?
Business Name
2. Other Business
What is your business EIN NUMBER
How much is your business income
Business Expenses
Did you use your vehicle for business?
Yes
No
How many miles did you place on your vehicle
Date you placed in service
BUSINESS DOCUMENTS EX (RECEIPTS* INVOICE *BUSINESS LEDGER) you make take a picture of your documents and upload them
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Did you receive unemployment? Please upload your 1099 G Statement at the end of the questionnaire in the upload documents square
Yes
No
Are you contributing to 401k or other pre-tax account?
Yes
No
Yes
Please select what kind of return you are filing ?
1040
1065
1040x
1120
Do you have any expenses for childcare?
Yes
No
What is the name of your childcare provider
What is the name of the childcare center or Provider
Do you have a gas or electric services in your name? How much did you pay this tax year for these services? ( if applicable )
What is the EIN of the Childcare Center or Social Security Number of the person who you paid childcare to
Do you have energy star rated improvements to your home?
Windows
Doors
Furnace
Other
Are you currently renting?
Yes
No
What is the monthly rental amount?
How long have you lived at the property?
# of months
What is the name of the Landlord or Property Management Company
# of months
Do you own your home?
Yes
No
Can you provide a copy of your property assessment statement and proof of payments made?
Yes
No
Did you sell any stock? Please provide supporting documents
Yes
No
Did you withdraw from your 401K or IRA ? (Please provide IRA /401K statement)
Yes
No
Do you have a mortgage? ( Please provide your mortgage interest statement)
Yes
No
Do you have real estate tax?
Yes
No
Did you receive a federal tax return last year?
Yes
No
Expenses
Please fill-up the information within the current year only.
General Expenses
Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses
Total Expenses
comments
How Do You Want Your Return?
Direct Deposit
PRE PAID DEBIT CARD
Check
Other
Routing Number
# of months
Accounting Number
# of months
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow HP TAX PROFESSIONALS 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 ABC Financial.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
File Upload
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of
Date Signed
-
Month
-
Day
Year
Date
Taxpayer Signature
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
Print
Submit
Submit
Do you have energy star rated improvements to your home?
Windows
Doors
Furnace
Other
Business Expenses
Should be Empty: