2024 New Client Intake Form

2024 New Client Intake Form

We appreciate your interest in our service. This form is for new clients ONLY. Please take the time 15-20 minutes of your time to complete this form. We will be accepting new clients on October 15, 2024.
What Tax Year(s) do you need Prepared?

2023202220212020Other
Filing Status

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Taxpayer Information
Name

First NameLast Name
Age
SS#
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Are you a full-time student?

YesNo
Are you totally and permanently disabled?

YesNo
Are you legally blind?

YesNo

Spouse Information
Name

First NameLast Name
SS#
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Are they a full-time student?

YesNo
Are they totally and permanently disabled?

YesNo
Are they legally blind?

YesNo
Are they your dependent?

YesNo

Dependents

Enter your dependents here

	Name	Date of Birth	Relationship
1
2
3
4
5
6

Dependent 1 (social security)

Cancelof
Dependent 2 (social security)

Cancelof
Dependent 3 (social security)

Cancelof

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
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Expenses
Please fill-up the information for year 2024 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

BUSINESS SECTION

Business Information

	Business Name	Services Offered	Business Structure (LLC, LLP, NON-PROFIT, S CORP)	EIN	BusinessEstablished Date
1
2
3
4
5
6

Business Tax Documents

Cancelof

Acknowledgment & Signature
I acknowledge that all information provided to Blue Signature is true and accurate to the best of my knowledge. I understand that I am required to have any supporting documentation to validate the information provided. Furthermore, I understand that knowingly providing false information on my tax return and reporting it to the IRS, I am taking part in a potentially criminal penalty situation which is punishable by law including but not limited to: facing court dates, restitution, and possible imprisonment. I waive Blue Signature and the preparer, of any error due to incorrect information provided by me. By signing below, I authorize Blue Signature to file my tax return.

I acknowlege by signing this form, if I and/or my spouse owes a federal/governement debt such as IRS, child support, student loans etc., I/we are still responsible for tax preparation fees due to Blue Signature at the time of service.
- I confirmed that all information I entered here is accurate and true.
- I allow Blue Signature to capture my sensitive data like personal ID, government ID, and other information.
- I have read the terms and conditions and privacy policy of Blue Signature.
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed

MonthDayYear
Date
Taxpayer Signature

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Date Signed

MonthDayYear
Date
Spouse Signature

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Should be Empty: