Tax Intake Form

CLIENT INTAKE
Please Complete - Sign and Submit

NEW & CURRENT CLIENTS

CASH ADVANCES UP TO $6000

STARTING JAN 2ND

NO CREDIT CHECK

24HR APPROVAL
Tax Prep Process: Two Easy Steps

PRE-ONBOARDING: CONSULTATION

If you would like to speak to us before filing, you may do so by calling your Tax Pro or 252-365-4100 during normal business hours where a dedicated team member will be awating to answer any questions you may have. However, due to the nature of the 2023 returns, we will NOT give out Free Estimates.

STEP 1: COMPLETE THE INTAKE FORM

Go through the intake form below to start the tax prep process. You can do so from the comfort of home. If you would like to make an appointment for a consultation you can do so virtually with your Tax Pro via zoom, in person at one of our office spaces, or by phone (although it is not required).

STEP 2: SIGN RETURN

We will notify you by email via DocuSign, when the return is complete for you to view and sign. Please view each page and ask questions before signing. After it has been filed, we will notify you once it has been accepted or rejected. If it has been rejected, we will reach out by text and email to get it resubmitted.
FILING FEES:

Option 1 $400: Single filers with no kids, no credits, basic deductions one W-2. The state return is included each additional W-2 is $25.

Option 2 $500: Single/HOH with dependents has W-2 only. The state return is included each additional W-2 is $25.

Option 3 Filers Self Employed/Business Owners $700:

Single/HOH or MFJ but Spouse has W-2 only $650: Self-employed, W-2 and 1099, all credits and deductions included. The state return is included as well.

How did you hear about us?

FacebookInstagramReferralPrevious Client

Tax Preparer NameType a question

If someone referred you, please type his or her name and contact number or a way to contact them.

Are you trying to buy a new home within the next 2 years?

YesNo

Are you interested in Credit Repair?

YesNo

Email

example@example.com

Tax Payers Name

First NameLast Name

Taxpayer's Phone Number*

Example: xxx-xxx-xxxx

Taxpayer's Job Title

Taxpayer's Date of Birth*

Example: 01/01/2001

Taxpayer's SSN

Example: xxx-xx-xxxx

Taxpayer's Email Address*

Spouse's Full Name

First Name

Spouse's SSN

Example: xxx-xx-xxxx

Name

First NameLast Name

Spouse's Date of Birth

Example: 01/01/2001

Spouse's Phone Number

Example: xxx-xxx-xxxx

Spouse's Email Address

Example: example@example.com

Taxpayer's SSN

Example: xxx-xx-xxxx

Spouse's Job Title

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you self employed?*

YesNo

What is your filing status?

Did you and your spouse live apart during the year?*

YesNoNot Applicable

What is your marital status as of December*

Single (Not Married)Married living with SpouseMarried not living with spouse

Did you pay over half the expenses of maintaining your residence for the entire year?*

YesNo

Did you support a child or family member for more than 6 months out of the year?*

YesNo

If yes, did you live together at any time after June 30, 2019?*

YesNoNot Applicable

Are you on any Government Assistance*

YesNoNot Applicable

How many dependents are you claiming?*

Dependent #1

First NameLast Name

Dependent #1 Date of Birth

01/01/2001

Dependent #1 SSN

What is Dependent #1's Relationship to you (son, daughter, etc.)?

How many months did Dependent #1 live with you in 2019? (If all year, enter 12)

Dependent #2

First NameLast Name

Dependent #2 Date of Birth

Example: 01/01/2001

Dependent #2 SSN

How many months did Dependent #2 live with you in 2019? (If all year, enter 12)

What is Dependent #2's Relationship to you (son, daughter, etc.)?

Dependent #3

First NameLast Name

Dependent #3's Date of Birth

01/01/2001

How many months did Dependent #3 live with you in 2019? (If all year, enter 12)

Dependent #3s SSN

Example: xxx-xx-xxxx

Dependent's #3 SSN

What is Dependent #3's Relationship to you (son, daughter, etc.)?

Dependent #4's First Name

First Name

Dependent #4's Last Name

Last Name

Dependent #4's Date of Birth

01/01/2001

Dependent #4's SSN

Example: xxx-xx-xxxx

What is Dependent #4's Relationship to you (son, daughter, etc.)?

How many months did Dependent #4 live with you in 2019? (If all year, enter 12)

Dependent #5's First Name

First Name

Dependent #5's Last Name

Last Name

Dependent #5's Date of Birth

01/01/2001

Dependent #5's SSN

Example: xxx-xx-xxxx

What is Dependent #5's Relationship to you (son, daughter, etc.)?

How many months did Dependent #5 live with you in 2019? (If all year, enter 12)

Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.

YesNo

Upload a copy of your daycare form here.

Browse Files

How would you like to receive your tax refund?

Check (Only available for in office visits)Direct Deposit

Name of Bank

Which type of account would you like your refund deposited into?

Checking AccountSavings AccountOther

Routing Number

Bank Account Number

Can someone else claim you as a dependent?

YesNo

Did you have health insurance in 2019?

YesNo

Did you have health insurance for the entire year?

YesNo

Who was your insurance cover through in 2019?

Was your insurance through your employer?

YesNo

Was your insurance through Medicaid?

YesNo

Was your insurance through the Affordable Care Act (The Marketplace)?

YesNo

Did your dependents have health insurance for the entire year?

YesNoNot Appliable

Was YOUR DEPENDENTS' insurance through your employer?

YesNoNot Applicable

Who was your Dependents insured with in 2019?

Upload Taxpayer & Dependent(s)Insurance Documents

Browse Files

Was YOUR DEPENDENTS' insurance through Medicaid?

YesNoNot Applicable

Was YOUR DEPENDENTS' insurance through the Affordable Care Act (The Marketplace)?

YesNoNot Applicable

Have you ever been denied the Earned Tax Credit (EITC)?

YesNo

Were you or any of your dependents in college in 2019?

YesNo

Did you trade any Virtual Currency

YesNo

Do you have a 1098-T Form for either you or your dependents?

YesNo

If you have a 1098-T form, upload it here.

Browse Files

Are you interested in AUDIT PROTECTION?

YesNo

CLIENT NON PAYMENT/OFFSET CLAUSE

At T3 Financial, we strive to assist all of our clients in their tax needs, howwever we understand that situations arise. If your refund is offset by the IRS, student loans, child support or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return.

By signing this agreement you acknowledge that if payment is not made in full with in 30 days legal actions will be sought to resolve payment.

Primary Taxpayer's Signature

I am giving T3 Financial permission to prepare all forms related to my tax return; to apply for and secure RAC's and RAL's on my behalf; and sign all necessary forms and file my taxes electronically. I take full responsibility for the accuracy of this form and understand that T3 Financial and/or associated affiliates hold no responsibility for any misrepresentation or false claims.

Date

Taxpayer's Signature (If no spouse, leave blank)

Spouse's Signature (If no spouse, leave blank)

Date

Type a question

Date

Taxpayer's Driver's License

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Taxpayer's and Dependent(s ) Social Security Card(s)

Browse Files

Taxpayer's W-2/ 1099'S

Browse Files

Dependent(s) Birth Certificate(s)

Browse Files

Dependent(s) Proof of Residency (Lease/Utility Bill)

Browse Files