Tax Return Client Intake Form

Tax Application

Client Intake Form

(Max Refund LEGALLY and receive a $6000.00 Cash Advance)
Part I. Taxpayer(s) Information
Taxpayer Name

First NameLast Name
Taxpayer Date of Birth

MonthDayYear
Date
Taxpayer Social Security Number
Taxpayer Phone Number
Cellphone Provider
Taxpayer Email Address
example@example.com
Taxpayer Occupation
Taxpayer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Married: Did you live with your spouse during any part of the last six months of 2022?

YesNo
What was your Marital Status as of December 31, 2023? (Check Answer)

SingleMarried
Spouse Name

First NameLast Name
Spouse Date of Birth

MonthDayYear
Date
Spouse Social Security Number
Spouse Phone Number
Spouse Email Address
example@example.com
Spouse Occupation
Check all that apply:

Can you be claimed as a dependent on someone else's returnWere you over age 18 and a full-time student at an eligible educational institution.Taxpayer is blind.Taxpayer is deceased.Taxpayer or Spouse served in a combat zone during the current tax year.Taxpayer wishes to elect to use their 2019 earned income to figure their 2021 earned income credit and/or child tax credit.Taxpayer or Spouse was affected by a natural disaster during the current tax year.Taxpayer has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.Taxpayer prefers to receive written communications from the IRS in a language other than English.Taxpayer prefers to receive written communications from the IRS in an accessible format.
Part II. Family and Dependent Information

DEPENDENTS INFORMATION: List the names of everyone below who lived in your home that you supported during the past 12 months.

	FULL NAME	DATE OF BIRTH	SOCIAL SECURITY NUMBER	# OF MONTHS DEPENDENT RESIDE WITH TAXPAYER
DEPENDENT 1
DEPENDENT 2
DEPENDENT 3
DEPENDENT 4

Do you have a "Special Needs" child?

YesNo
Part III. Income

Did you or your spouse receive any of the following? (Check Yes or No to all questions below)
Did you or your spouse receive any of the following? Please select ALL that applies and attach documents below.

W-2 (W-2 Employee) or SalarySelf Employment Income (such as earnings from contract labor and small business, etc.)1099 MISC or NECDisability IncomeUnemployment CompensationOther income: (gambling, lottery, prizes, awards, jury duty, etc.)
Also, please attach the following documents.

Taxpayer(s) Driver's LicenseSocial Security Cards for all Taxpayer(s) and Dependent(s)Proof of ResidencyHealthcare Card for Taxpayer(s)/Dependent(s)
File Upload

Cancelof
Please select all that applies and attach supporting documents below.

Contributed to an IRA, 401k, or other retirement account, including employer retirement account.Own a home (Please attach mortgage statement, interest and taxes)Paid child care expenses (daycare or an individual to baby sit your children) Please provide the Daycare /individual (Name, SSN or EIN, address and amount paid)Rented a home (Identify landlord, address and monthly rent)Paid College Tuition for yourself, spouse or dependent (Form 1098T)Had educational expenses this year (such as a computer, books, etc.)Paid on a student loan this year?Received health coverage (Insurance) through your state marketplace or healthcare.gov? If so, please upload form 1095A
File Upload

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If you would like your tax refund (if any) deposited directly into your bank

CheckingSavings
Bank Name
Your Account Number
Bank Routing Number
Part IV. Business Income & Expenses (Sole Proprietorship, LLC)

Please skip this section if you DO NOT operate a business.
Owner Name

First NameLast Name
Business name
Employer ID number (EIN)
Business Type
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you use any part of your home regularly and exclusively for business?

YesNo
Estimated percentage of time spent in home office compared to total time spent in this business
Estimated time in home office compared to total time in this business
Description of work done in home office
Description of work done outside of work office
Total area of home
Total area of home used regularly for business
PART V. Additional Information
Does anyone listed on the Tax Return have an Identity Pin? If so, please list the name and Identity Pin below:
PLEASE ENTER YOUR TAX PREPARER NAME BELOW:
Consent to Use of Tax Return Information
Federal law requires this consent form be provided to you ("you" refers to each taxpayer, if more than one). Unless authorized by law, we cannot use, without your consent, your tax return information for purposes other than the preparation and filing of your tax return.

You are not required to complete this form. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year.

If you do not consent, then you may still have your tax return prepared and electronically filed by us for a fee.

For your convenience, we have entered into arrangements with a bank to provide qualifying taxpayers with the opportunity to apply for a Refund Anticipation Loan (RAL), or Electronic Refund Check or Electronic Refund Deposit. To determine whether these products may be available to you, we will need to use your tax return information by analyzing it and calculating the amount of your anticipated refund.

If you would like us to use your tax return information to determine whether these products may be available to you while we are preparing your return, please sign and date this consent to the use of your tax return information.

By signing below, you (including each of you if there is more than one taxpayer) authorize us to use the information you provide to us during the preparation of your 2023 tax return to determine whether to present you with the opportunity to apply for these products and services and you attest under penalty of perjury that the above information is true.
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Tax Application

Client Intake Form

Part I. Taxpayer(s) Information

Part II. Family and Dependent Information

Part III. Income

PART V. Additional Information