TPC Financial Solutions Client Intake Form

Client Tax Data Sheet

Fill out the form below to submit your tax information to me. If you have any questions prior to completing this form, do not hesitate to contact me by email tpc@thepeopleschoicefs.com or by phone at (901)249-7854. Thank you and have a great day!
How did you hear about us or who referred you?
First Name*
Middle Name
Last Name*
Suffix
Jr, Sr, II, III
Social Security Number*
Date of Birth*

MonthDayYear
Date
Occupation*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Driver's License #*
State Driver's License Was Issued*
Date Driver's License Was Issued *
MM/DD/YYYY
Driver's License Expiration Date*
MM/DD/YYYY
Photo of Social Sec. Card & Driver's License *

Choose File
Identification Cancelof
What is your filing status?*
Are you filing an eligible spouse on your tax return?*

YesNo
Do you have an IP Protection Pin or not?

Yes*No
Enter IP Protection Pin

Spouse Name

First NameMiddle NameLast NameSuffix
Social Security Number*
Occupation*
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Driver's License #*
State Driver's License Was Issued*
Date Driver's License Was Issued *
MM/DD/YYYY
Driver's License Expiration Date*
MM/DD/YYYY
Photo of Driver's License *

Choose File
Identification Cancelof

Dependents

Should only be listed if you take care of the dependent over half of the year
Image of Dependent's S.S.Card*

Choose Files
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1. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Date Of Birth*

MonthDayYear
Date
Social Security Number*
Do you want to enter another dependent?*

YesNo, all dependents are entered
2. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Date Of Birth*

MonthDayYear
Date
Social Security Number*
Do you want to enter another dependent?*

YesNo, all dependents are entered
3. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Date Of Birth*

MonthDayYear
Date
Social Security Number*
Do you want to enter another dependent?*

YesNo, all dependents are entered
4. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Date Of Birth*

MonthDayYear
Date
Social Security Number*
Did you pay any child care expenses throughout the year ?

YesNo

Child and Dependent Daycare Expenses

If the provider is a person, enter the care provider's SSN
Child Name Amount Paid*

First NameAmount Paid
Provider Phone Number*

Area CodePhone Number
Provider*

NameTax ID #/ SSN
Provider Address*

Street Address

Street Address Line 2

CityState

Zip Code
Do you want to enter another child care provider?*

YesNo
Child Name Amount Paid*

First NameAmount Paid
Provider*

NameTax ID #/ SSN
Provider Phone Number*

Area CodePhone Number
Provider Address*

Street Address

Street Address Line 2

CityState

Zip Code

Upload photos of your W-2,1099,and ALL documents

Attach an image of all documents that can be used to assist your tax preparer with the preparation of your tax return.
Upload*

Choose Files

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Enter any additional information or comments that you would like the include for your tax preparer
If you did not file your tax return with us last year, we recommend that you upload a copy of your previous year's tax return

Choose Files
Optional but STRONGLY recommended Cancelof
Do you owe from previous years?

YesNoI have not filed previous years
Please select the following years you are trying to file

2019201820172016
Do you have a business that you would like to be included on your return?*

YesNo

Business Owners Data Sheet

Schedule C
Name of Business*
Employer ID Number
EIN
What is the legal structure of your business?*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Amount of business taxes paid throughout the year?
$
Business Income

All income receive during the fiscal year
Total Income
$
Business Expenses

Complete to the best of your ability. In each field enter the approximate amount you spent in each category.
Advertising
Social media, Flyers, Business Cards, etc
Contract Labor
An person or company paid to assist you
Insurance
(Other than health)
Interest
Mortgage, Loans, Credit Cards, etc.
Legal & Professional Services
Training, Conferences, Mentors, Lawyers, etc
Office Expenses
Software, postage, email, internet, and any operating expenses
Rent and Lease
Vehicles, Machinery, Equipment, Electronics, Accessories, etc.
Repairs and Maintenance
Supplies
Objects used to operate your business
Taxes and Licenses
Travel, Meals, and Entertainment
Airfare, Uber, Taxi, Lyft, Business Dining, Business Entertainment, and etc.
Utilities
Other Expenses
Is there any other information, questions, or concerns that you want to include to your tax preparer pertaining to your business?
Attach any photos or documents that you want us to have on file.

Choose Files

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Acknowledgement

Please read the following statements and sign below. I or we acknowledge that the information submitted to TPC Financial Solutions, LLC. to prepare my or our tax return can be substantiated by receipts, canceled checks, and other documentation.

This information was provided to TPC Financial Solutions, LLC. is true, accurate and complete to the best of my or our knowledge.
I or we also understand that in the event of an audit, that I or we are responsible for gathering all necessary information for the audit. I or we also understand that I or we may request the assistance of The People’s Choice, LLC in helping to put such
information together for the IRS or TN Department of Revenue.
I or we also, understand, that as a taxpayer, I or we are responsible for my or our own tax return and that I or we can’t hold TPC Financial Solutions, harmless for any misrepresentation of information. I or we may have provided to the preparer.

I/we have received and read this statement of the company’s private policy and understand that I/we tax return information is kept confidential between. and my or we and TPC Financial Solutions, LLC. I must submit written authorization to TPC
Financial Solutions, LLC. before any copy or fax of my return(s) information will be released to any outside party. (Example: mortgage company, financial institutions, educational
institutions, etc.)

*PRIVACY ACT: We reserve the right to use your contact information to email, text, call or mail you with advertisement or promotional materials.
Taxpayer’s Signature:*

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Taxpayer’s Signature Date

MonthDayYear
Date
Spouse’s Signature:

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Spouse’s Signature Date

MonthDayYear
Date

Auto- Collect Acknowledgement
The People’s Choice, LLC
2504 Mount Moriah D303
Memphis, TN 38115

To all Pay by refund clients
TPC Financial Solutions, LLC, is a tax service provider. The fee charged to the client is for tax preparation. If you owe any dues to the IRS and/or any other government entity and your refund is offset with your tax return, if your return cannot cover your prep fees, you the client is responsible for paying your tax fees
out of pocket.

TPG contacts unfunded taxpayers
Once a taxpayer is at least a month past their expected IRS funding date, TPG will begin sending you a series of emails or a written notice giving you the option to conveniently pay your tax preparation fees using their credit or debit card.

Your fees are direct debited
If you do not respond by paying with their bank debit or credit card, TPG will direct debit your tax preparation fees from your bank account. TPC is committed to working with our clients on any tax situation. Communication is key and vital to ensure a business relationship of integrity.
Taxpayer Signature*

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Date

MonthDayYear
Date
Spouse Signature

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Date

MonthDayYear
Date

E- Signature Below*

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By filling out this form, you are giving us permission to prepare your tax return and you are confirming that ALL information entered is accurate. If you have any questions do not hesitate to call our office at (901)249-7854 or email tpc@thepeopleschoicefs.com
Should be Empty:

Client Tax Data Sheet

Payment/Refund

Dependents

Child and Dependent Daycare Expenses

Upload photos of your W-2,1099,and ALL documents

Business Owners Data Sheet

Business Income

Business Expenses