YOUR INFORMATION IS SECURELY ENCRYPTED AND PROTECTED. IT WILL ONLY BE USED FOR ITS INTENDED PURPOSE.
CLIENT INTAKE SHEET
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Referred By:
Are you a new client ?
Yes
No
From the D&C TAX SOLUTIONS Team, who will be representing for handling your tax filings. Please provide the representative’s name.
Tax Representative:
*
Please Select
I NEED ONE
CHARLY VERNITUS
DEAN BAPTISTE
SINDY VERITUS
MAO MALETTE
LORAINE FLEURANT
NAITCHA VERNITUS
LOVINSKY MARC
JACQUES DAUTRUCHE
PORSCHE OUTING
LONSARD DENIS
AMARI NOWELL
GRAHAM ANDRE
DAVIDSON FONTUS
MARVIN SIFFORT
SIDNEY JACQUES
NATHALIE ESTELLA
RANDY L JOHNSON
ALBERT C KOLUBAH
JULIAN SIAW
EDMOND PHILIPPE
WADERNO PIERRE
Filing Status
*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Tax Payer Information
SSN
*
Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
DRIVER LICENSE
*
Browse Files
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Phone/Mobile
*
Please enter a valid phone number.
Format: Mobile Number.
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Cell phone carrier
Verizon
Att
Metro
Boost
Cox
T-Mobile
Spectrum
Other
Email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you a full-time student? If yes upload 1098-T Form
Yes
No
P PIN #
Taxpayer's Citizenship with the US?
Citizen
Resident
Non-Resident Alien
If the Taxpayer is not a Citizen of the US, enter Country of Citizenship
Spouse Information
SSN #
Name
First Name
Middle Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
DRIVER LICENSE
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Phone/Mobile
Please enter a valid phone number.
Format: Mobile Number.
Email
example@example.com
Are they a full-time student? If so upload 1098-T Form
Yes
No
Are they your dependent?
Yes
No
P PIN #
Taxpayer's Citizenship with the US?
Citizen
Resident
Non-Resident Alien
If the Taxpayer is not a Citizen of the US, enter Country of Citizenship
DEPENDENTS
Enter your dependents here
Rows
Name
SSN
Date of Birth
Relationship
1
2
3
P PIN #
TAX RELATED QUESTIONS
Employment Status
Employed
Self-employed
Unemployed
Do you have any expenses for child care?
Yes
No
Do you have your own home?
Yes
No
Do you have documents that shows you paid for property taxes?
Yes
No
Did you take money from your 401K?
Yes
No
Do you have mortgage interest?
Yes
No
Did you or any family member on this return purchased health insurance through the "Marketplace" in 2024 years or ( received Form 1095-A ) ?
Yes
No
Did you receive a federal tax refund last year?
Yes
No
Do you have due IRS Obligations? If you're not sure, we can help.
Yes
No
Are you a victim of identity theft? If so please provide your identity protection pin
Yes
No
Did you have any courier jobs? ex:(uber, Lyft, Instacart , and more)
Yes
No
Did you finance a vehicle in 2025?
Yes
No
Please Upload all necessary documents for your tax filing. Copy of your Social, W2, 1095-A Form, 1099’s, Dependents Social, 1098-T Student Form, Unemployment Form, and all other documents necessary such as LLC loss and profit documents. (PLEASE ENSURE ALL UPLOADED DOCUMENTS ARE LEGIBLE)
Browse Files
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of
Did you receive Over-Time or Tips from Employer? ( Last Paystub) (PLEASE ENSURE ALL UPLOADED DOCUMENTS ARE LEGIBLE)
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of
Checklist Upload Verification:
*
Copy Of Social
Copy Of W2's
Copy Of Driver License
Dependents Information ( Social & Due Diligence Documents)
Unemployment Form
1098T
1095-A
All Other Documents
File Upload
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Drag and drop files here
Choose a file
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of
Bank Name:
First Name
Last Name
SBTPG (Santa Barbara Tax Products Group) Disclosure
REFUND PROCESSING DISCLOSURE & AUTHORIZATION
D&C TaxSolutions uses Santa Barbara Tax Products Group (SBTPG) as a third-party refund processing partner to facilitate tax refund disbursement and ensure authorized preparation fees are properly collected. Under this process: •Your tax refund is first sent to SBTPG. •Authorized tax preparation and related service fees are deducted. •The remaining refund balance is then issued to you based onyour selected refund method's may charge additional processing fees. Refund timing is determined by the IRS and SBTPG, not D&C Tax Solutions. By signing below, you acknowledge and authorize the use of Santa Barbara Tax Products Group for refund processing as part of our standard service procedures.
Taxpayer Signature
*
Do you understand and authorize D&C to use SBTPG?
*
Yes
No
Bank Name:
Account #
Routing #
Bank Info:
Account #
Routing #
Account Type:
Checking
Savings
PrePaid Card
TAX OFFICE LOCATIONS
Do you require in office consultation?
Yes
No
Office Locations
1741 OCOEE APOPKA RD. Apopka, FL 32703
11080 OLD ROSWELL RD. Suite 203B Alpharetta, GA 30009
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Bank
Detected Location
Acknowledgment & Consent
I confirmed that all information I entered here is accurate and true.
I allow D&C TAX SOLUTIONS 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 D&C TAX SOLUTIONS.
By clicking yes, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
I confirmed that all information I entered here is accurate and true.
YES
NO
I allow D&C TAX SOLUTIONS to capture my sensitive data like personal id, government id, social security number (SSN), and other information.
YES
NO
I have read the terms and conditions and privacy policy of D&C TAX SOLUTIONS.
YES
NO
I acknowledge that I have read and understood my responsibilities and our responsibilities in doing this tax return.
YES
NO
I acknowledge that I have read and understood my responsibilities and our responsibilities in doing this tax return.
YES
NO
Type option 2
Type option 3
Type option 4
Date Signed
-
Month
-
Day
Year
Date
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
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Taxpayer Signature
*
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