Tax Client Intake Form

How did you hear about us?

What tax year are you filing?

What is your martial status as of December 2025?

Name

First NameMiddle NameLast NameSuffix

Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Phone Carrier

Email

example@example.com

Occupation

Does any of the following apply?

Social Security Number

Date of Birth

Date

Date of Death

Date

Driver's License or I.D. card number

Issue Date

Date

Expiration Date

Date

Please upload the front ID/DL and Social Security Card.

Spouse Name

First NameMiddle NameLast NameSuffix

Spouse Social Security Number

Spouse Date of Birth

Date

Spouse Date of Death

Date

Spouse Driver's License or I.D. Card Number

Spouse Issue Date

Date

Spouse Expiration Date

Date

Spouse Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Spouse Email

example@example.com

Please upload the front ID/DL and Social Security Card.

Please take clear photos.

Please upload a December 2025 utility bill, lease agreement, mortgage statement or other household documents to prove expenses.

Do you have income? Describe what kind of income you have.

Can someone else claim you as a dependent?

Were you unmarried, or are considered unmarried on the last day of the year?

Did you pay more than half of the cost of keeping up a home for the year?

Pick one of the 3 options that you will submit to be approved to file Head of Household.

Did you pay someone to watch your child/children?

Did you receive social security or retirement income?

Were you ever disallowed the E.I.T.C prior to this year?

Did you receive unemployment compensation (1099-G) regular or PUA last year?

If yes, did you receive regular unemployment or PUA?

Do you have any W-2(s) income?

If yes, how many W-2s are you filing for 2025?

Did you make college tuition payments or receive a 1098-T Form last year?

Did you receive Self-Employed Income?

Please list any other income that we should know about that's not listed.

Did you purchase insurance from the Marketplace OR have any premium credits from the Insurance company you use?

Who were your Dependents insured with in 2025?

Do you owe any delinquent

Would you like to apply for a refund advance for up to $7000 (Please note that we aren't able to choose advance amounts)

Dependent #1 Name

First NameLast Name

Date of Birth

Date

Social Security Number

Relationship to Taxpayer

Did your dependent live with you more than half the year?

Dependent #2 Name

First NameLast Name

Date of Birth

Date

Social Security Number

Relationship to Taxpayer

Did your dependent live with you more than half the year?

Dependent #3 Name

First NameLast Name

Date of Birth

Date

Social Security Number

Relationship to Taxpayer

Did your dependent live with you more than half the year?

If claiming son/daughter, where is the other parent of the dependent/dependents? Is the other parent providing any financial support?

If claiming brother or sister, how are you related to the dependent? Where are the parents of the dependent/dependents?

If claiming niece, nephew, aunt, or uncle, how are you related to the dependent? Where are the parents of the dependent/dependents?

Please upload a copy of the dependents social security cards OR other document that has SSN on it.

Please take clear photos.

Is your child/children under 19 years of age, at the end of the year, or is under 24 years of age at the end of the year and is a full time student, or was permanently and totally disabled at any time during the tax year, regardless of age?

Is your home in the United States?

If your child/children is/are the qualifying child/children of another individual, are you the only person claiming the credit for that/those child/children during the tax year?

Name of parent(s) or guardian(s).

Dates the dependent(s) lived with you in the 2025 calendar year. (Ex. Jan 1 –Dec 31)

Address that your dependent(s) lived at with you in the 2025 calendar year.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

List All Dependents That Lived With You From Your Tax Return.

I am certifying that the dependent(s) listed above that I am claiming on my 2025 tax return has lived with me at the address above for more than 6 months in 2025 in the United States. If I was audited by the IRS for EITC, Head of Household, or Child Tax Credit; I would be able to provide the document(s) below to prove residency of my dependents:

By checking this box AND affixing my signature to this form, I hereby affirm under penalty of perjury that the facts set forth in this statement are true.

Tax Payer Full Name

Tax Payer Signature

Date

Spouse Full Name

Spouse Signature

Date

Please select each type of income that you received for the 2025 year.

Upload your income document(s).

We need the entire form, with all numbers showing. Please take clear photos.

Which of the following applies to you?

How would you like your refund?

Bank Name

Routing Number

Account Number

I,   First Name   Last Name , have provided accurate information to Preferred Tax Service in order complete my 2025 Income Tax. I also understand that Preferred Tax Service WILL NOT participate in any tax fraud. I have read over the information entered on both my Federal and State Income Tax Return to verify information was entered accurately and consent to electronic filing both returns on my behalf.

I,   First Name   Last Name   , understand that if my probable taxes are greater than projected tax refund. I will be required to pay the tax preparation fees out of pocket at the time my tax returns are being prepared. If at any time I am audited, it is solely my responsibility and not the responsibility of Preferred Tax to handle whatever issues there may be with my 2025 Federal and State Income Tax, although we are here to assist.

I,   First Name   Last Name   , understand that I am responsible for bringing all required documents that Preferred Tax requires to file my 2025 income tax return. During the initial interview with Preferred Tax, I was informed on what documentation would be required and I understand that I am not obligated to file my tax return with Preferred Tax. If I choose to file with Preferred Tax, I agree to provide documents required but not limited to: Valid Government ID, Social Security Cards, Income Documents, Proof of Residency and any other significant documents required in order to accurately complete both my Federal and State returns. Preferred Tax reserves the right to delay or deny preparations services if I fail to provide such documents. I understand that it is my option to use Bank Products offered and understand that bank products will not be refunded any faster than refunds issued directly from the IRS. By signing your name and submitting this document, you are agreeing all information provided is correct and true. The IRS will penalize anyone who gives false or inaccurate information.

Taxpayer Signature

Enter Today's Date

Date

Spouse Signature

Enter Today's Date

Date

Preferred Tax Service Client Intake Form

TAXPAYER INFORMATION

SPOUSE INFORMATION

Head of Household Requirement

Questionnaire

DEPENDENT(S) INFORMATION

SWORN STATEMENT OF RESIDENCY

INCOME

DEDUCTIONS & CREDITS

REFUND SELECTION

Direct Deposit Information

PREFERRED TAX SERVICE DOCUMENT AGREEMENT