New Client Intake Form
Before you start please any Tax Documents (W-2)(1099), ID, Birth Certificate and Social Security Card ready for upload.
Name
*
First Name
Last Name
Social Security Number
*
Occupation
*
Phone Number
*
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
W-2/1099 Upload
*
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Birth Certificate Upload
*
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Social Security Card Upload
*
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ID Upload
*
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Filling Status
*
Single
Married Filling Jointly
Married Filling Separately
Head of Household
Spouses Name
Spouses Social Security Number
Spouses Occupation
Spouses Date of Birth
-
Month
-
Day
Year
Date
Spouses Phone Number
Please enter a valid phone number.
Dependent 1 Full Name
Dependent 1 Social Security Number
Dependent 1 Relationship
Dependent 1 Date of Birth
-
Month
-
Day
Year
Date
Dependent 2 Full Name
Dependent 2 Social Security Number
Dependent 2 Relationship
Dependent 2 Date of Birth
-
Month
-
Day
Year
Date
Dependent 3 Full Name
Dependent 3 Relationship
Dependent 3 Social Security Number
Dependent 3 Date of Birth
-
Month
-
Day
Year
Date
Dependents Social Security Card Upload
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Dependents Birth Certificate Upload
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Did you have Health Insurance? If so, select which coverage applies to you
*
Employer
Spouse Insurance
Exchange/Market Place
Direct W/ Insurer
Did your spouse have Health Insurance? If so, select which coverage applies
Employer
Spouse Insurance
Exchange/Market Place
Direct W/ Insurer
Did your Dependents have Health Insurance? If so, select which coverage applies
Employer
Spouse Insurance
Exchange/Market Place
Direct W/ Insurer
Did any of your dependents Have daycare?
Yes
No
Did you receive any Tax Forms from your care provider?
Yes
No
Name of child
Name of Care Provider
Did all of your children receive care? If not, Please explain
Tax Form from Care Provider
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Do you have a child over the age 18 that attends College in 2024?
If yes did you receive a 1098T?
Back
Next
Have you received an Ipin from the IRS
*
Were you affected by a Natural Disaster?
Yes
No
If yes, Please provide State and which the disaster Occurred
Do you currently owe any of the following Govt Entity?
Child Support
Unemployment
IRS
Student Loans
Did you operate a Business this year in 2024?
If yes please provide the following information: Business name, EIN, Business Type
Did you receive any 1099s?
How would you like to receive your tax refund?
Please Select
Check
Direct Deposit
Direct Deposit w/ cash advance
Would you like to apply for a Tax Advance?
Yes
No
Please Provide a Void Check or Direct Deposit Slip for account information
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I declare that I understand the above questions and have answered them truthfully to the best of my ability.
Date
-
Month
-
Day
Year
Date
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