Tax Preparation Client Intake Form
281-969-1695 | victor@vbetax.com | VBETAX.COM
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
SSN
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Are you legally blind?
Yes
No
Spouse Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
SSN
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they legally blind?
Yes
No
Are they your dependent?
Yes
No
Dependents
Enter your dependents here
Name
SSN
Date of Birth
Relationship
1
2
3
4
5
6
Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
Yes/No
Employer
Spouse Ins
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Tax Related Questions
Employment Status
Employed
Unemployed
Self-employed
Are you contributing to 401k or other pre-tax account?
Yes
No
Is this your first time opening a pre-tax account?
Yes
No
Please select what state return are you requesting?
State return
School
Local
RITA
Country returns
Does your dependents have tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
Do you have energy star rated improvements to your home?
Windows
Doors
Furnace
Other
Are you currently renting?
Yes
No
What is the monthly rental amount?
How long have you lived at the property?
# of months
Do you have your own home?
Yes
No
Do you have documents that shows you paid for property taxes?
Yes
No
Did you sell any stock?
Yes
No
Did you take money from your 401?
Yes
No
Did you pay your vehicle tax?
Yes
No
Do you have mortgage interest?
Yes
No
Do you have real estate tax?
Yes
No
Did you receive a federal tax last year?
Yes
No
Are you a victim of identity theft?
Yes
No
Expenses
Please fill-up the information within the current year only.
General Expenses
Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses
Total Expenses
Additional comments
Upload Documents
Upload Driver License/ID
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload SSN card and Selfie
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload W2/1099/all Income documents
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Direct Deposit/Withdrawal
Bank Name - Direct Deposit/Withdrawal
Bank Name
Account Number
Account Number
Confirmed Account Number
Confirmed Account Number
Routing Number
Routing Number
Confirmed Routing Number
Confirmed Routing Number
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true. I allow VBE Tax and Business Formation Services (VBE TAX) 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 VBE TAX
Our engagment to prepare your tax returns will conclude with the delivery of the completed returns to you (if paper-filing), or your signature and our subsequent submittal of your tax return (if e-filing). If you have not selected to e-file your returns with our office, you will be solely responsible to file the returns with the appropriate taxing authorities. Review all tax return documents carefully before signing them. You agree to allow VBE TAX to file your tax return and understand that we do not give quotes to be comparable to DIY tax software. By signing this agreement, your signature is now transferrable to the forms 1040, 8879, 7216 and all other applicable forms in the finalized tax return from this document for submission.
Request for a tax estimate quote will cost: $50 for single and $75 for joint filer and will be debited from your bank account.
To affirm that this letter is correctly summarizes your understanding of the arrangements for this work, you agree to allow VBE TAX to file your tax return and not just give you a quote and your signature is transferrable to the tax return fromthis document, please sign below:
Date Signed
-
Month
-
Day
Year
Date
Taxpayer Signature
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
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Submit
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