Tax Client Intake Form

Signature Consulting Intake Form

Thank you for taking time to complete your 2023 Client Questionnaire. For new clients, this information is critical to ensure we accurately file your tax return. For existing clients, we kindly request you provide this information again to ensure our records are 100% accurate and up to date.
IMPORTANT, PLEASE READ!

UPON COMPLETION OF ALL APPLICABLE PARTS OF THIS FORM YOU MUST CLICK THE "SUBMIT" BUTTON AT THE BOTTOM OF THE FORM TO SEND THIS INFO TO OUR OFFICE. CLOSING YOUR BROWSER BEFORE CLICKING THE "SUBMIT" BUTTON WILL DELETE ALL INFO WITHOUT SENDING IT TO US. IT SHOULD BE NOTED THAT UPON CLICKING THE SUBMIT BUTTON YOU WILL GET A CONFIRMATION EMAIL THAT WE RECEIVED YOUR INFORMATION.
Please also note that to comply with federal and state identity theft protection efforts, our firm will ask for a valid state issued photo identification card during your engagement.

***The page is highly secure. We use industry-leading technology Secured Socket Layer (SSL) to keep your information safe. All sensitive information is securely transmitted and can not be compromised***

This questionnaire may take you up to 20 minutes to complete. Please be sure to organize all of your tax documents prior to completing the form.

Please complete this form in it's entirety. Missing documents will delay the processing and filing of your tax return.
Choose Your Tax Consultant*
Are you New or Existing client of Signature?*
If you are a new client can you provide a copy of your prior year tax return?*

YesNoExisting Client
Do you have any unfiled tax returns from previous years?*

YesNo
What Tax Years do you need Prepared or Amended?*

2023202220212020 or LaterPrior Year Amendment
Tax Payer Information
Filing Status*

SingleMarried Filinf JointMarried Filing SeperateHead Of HouseholdQualifiying WidowerUnsure
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail
example@example.com
Date of Birth*
SSN*
Occupation*
Are you a full-time Student?*

YesNo
Are you disabled?*

YesNo
Do you have an IP PIN from the IRS?*

YesNo
If yes, what is your six digit IP PIN?
At any time during 2023, did you: (a) receive (as a reward, award, or payment for property or services); or (b) sell, exchange, gift, or otherwise dispose of a digital asset (or a financial interest in a digital asset)?*

YesNo
Did you recieve any type of supplemental income such as child support, food stamps social security, welfare benefits or housing assistance?*

YesNo
Employmemnt Status*

EmployedRetiredUnemployedSelf-EmployedMiltary Full Time
Did you, your spouse or any dependents attend college in 2023?*

YesNo
Did you or spouse if applicable recieve unemployment benefits in 2023?*

YesNo
Did you or your spouse receive a 1099-C form (cancellation of debt) in 2023?*

YesNo
Upload 1099 C Cancellation of Debt Form (Charged off Accounts)

Cancelof
Do you own your home?*

YesNo
Do you plan to purchase a home within the next one or two years?*

YesNo
Do you have Mortgage Interest or Real estate tax?*

YesNo
1098 Mortgage Form

Cancelof
Did you have any home improvments?*

WindowsSolar PanelsFurnaceDoorsOtherNone
Did you buy or sell stock?*

YesNo
Did you or your spouse sell, acquire, send, receive or exchange any virtual currency?*

YesNo
Are you contributing to a 401k or other pre-tax account?*

YesNo
Did you withdraw money from your 401k or other pre-tax account in 2023?*

YesNo
Did you or your spouse make any charitable contributions in 2023? (Goodwill, Salvation Army, Church etc.)?*

YesNo
Did you or your spouse make any charitable cash contributions of $500 or more in 2023?*

YesNo
Did you or your spouse purchase an electric vehicle in 2023?*

YesNo
Did you or your spouse purchase a vehicle in 2023?*

YesNo
Did you receive a federal income tax refund last year?*

YesNo
Did you or your spouse make payments on your student loans in 2023?*

YesNo
Did you or your spouse have any gambling winnings in 2023?*

YesNo
W2G Gambling Forms

Cancelof
Did you or your spouse receive any earnings from interest or dividends in 2023*

YesNo
Government ID, Driver License or Passport*

Cancelof
Taxpayer Social Secruity Card

Cancelof
Upload ALL Taxpayer Income Documents (W-2, 1099, 1099K, 1099R and ETC)*

Cancelof
Upload 1095-A Health Insurance Statement

Cancelof
Upload 1098-T School Form

Cancelof
How would you like to receive your refund*

Direct DepositCheckPrepaid Card
Banking Information (Please fill out if you selected direct deposit)

Spouse Information (ONLY IF FILING A JOINT RETURN OR MARRIED FILING SEPERATE. PLEASE SKIP IF THIS DOESN'T APPLY!
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
DATE OF BIRTH
SSN
Is your Spouse a fulltime student?

YesNo
Is your spouse disabled or blind?

YesNo
Were your spouse previously issued an Identity Protection PIN (IP PIN) by the IRS?

YesNo
If yes, what is your IP PIN?
Did your spouse work in 2023?

YesNo
Spouse Government ID, Drivers License or Passport

Cancelof
Spouse Social Secruity Card

Cancelof
Spouse Income documents (W2, 1099)

Cancelof

Dependents
Do you have dependents?*

YesNo
Did your dependents stay with you for at least 6 months?

YesNo
Are they a dependent of another person?

YesNo
Can the dependent be claimed on anyone else's return?

YesNo
Have you ever been disallowed for EITC/AOTC/CTC?ACTC?*

YesNoUnsureN/A

Please complete your dependent information here

	Full Name	SSN	DOB	Relationship	Student	Disabled	How many months did the dependent live with you in 2022
1
2
3
4
5

Do you have child care expenses?

YesNo
Upload Childcare Records

Cancelof
Dependent Social Security Cards

Cancelof
Dependent Birth Certificates or Government ID

Cancelof

Self-Employment
Are you or your spouse a business owner or self-employed?*

YesNo
How much was your income for the year?
If requested from the IRS will you be able to provide proof of your business and how you compute your income?

YesNo

Business Information

	Business Name	EIN	Do you have a legal business structure (LLC) registered with the Secretary of State?	What type of goods or services do you offer to your clients?	What is your Business Entity? (LLC, C Corp, S Corp, Non-Profit, Partnership or Sole Proprietorship?
1
2
3
4
5

Do you or your spouse owe debt to any Government Agency; such as IRS, Student Loans, Child Support etc.?*

YesNo
Which government agency do you owe, and how much?
Please call the Debt Offset Hotline at 1-800-304-3107 to confirm your government debt agency and amount prior to your appointment.
Additional Comments or Anything we should know about.
How did you hear about Signature?
I acknowledge that all information provided to Signature Consulting INC is true and accurate to the best of my knowledge. I understand that I am required to have any supporting documentation to validate the information provided. Furthermore, I understand that knowingly providing false information on my tax return and reporting it to the IRS, I am taking part in a potentially criminal penalty situation which is punishable by law including but not limited to: facing court dates, restitution, and possible imprisonment. I waive Signature Consulting INC and the preparer, of any error due to incorrect information provided by me. By signing below, I authorize Signature Consulting INC to file my tax return.

I acknowlege by signing this form, if I and/or my spouse owes a federal/governement debt such as IRS, child support, student loans etc., I/we are still responsible for tax preparation fees due to Signature Consulting INC at the time of service. Also, if the federal refund amount is mailed, I/we are still responsible for the tax preparation fees stated on the invoice. If the tax preparation fees are not paid, I understand Signature Consulting INC will take legal action to collect the unpaid tax preparation fees.
Signature*

Clear
Date*

MonthDayYear
Date
Spouse Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Signature Consulting Intake Form

IMPORTANT, PLEASE READ!