Tax Preparation Client Intake Form

Tax Preparation Client Intake Form

Established Grace Tax Preparation Services
Thank You for taking the time to complete your Client Intake Form. This information is critical to ensure your tax return is filed accurately. Please take your time and review all information before you submit. Please note that if documents are missing or information is incorrect this will result in a delay in processing your return. This intake form will take 20- 30 minutes to complete. * Please complete this form in its ENTIRETY and click SUBMIT when finished. ** Upload all documents at the end of the form. *** Please wait until you have ALL of your documents before submitting this form.

Note: If you are claiming any dependents, be sure to upload their SS CARDS, BIRTH CERTIFICATES, and all items that show their address is the same as yours. (e.g. school records, medical records, doctor bills, Medicaid Statement, Social Services Records, or anything that shows your child's name and current address).
How did you hear about us?*
Which tax year are you filing for?
Did you file taxes last year (2023)?
2023 tax return (or last tax return filed)

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Did you get a refund or did you owe?
Who filed your taxes last year?
Interview Setting:

In personVirtualTranslator Used

Spouse Information
Name

First NameLast Name
Age
Date of Birth

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Employer

Dependents

Enter your dependents here

	Name	Date of Birth	Relationship
1
2
3
4
5
6

Did 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 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

Additional comments

Acknowledgment & Signature
- I confirmed that all information I entered here is accurate and true.
- I allow Established Grace Enterprises to capture my sensitive data like personal id, government id, and other information.
- I have read the terms and conditions and privacy policy of Established Grace Enterprises.
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Upon receipt of your completed intake form an interview will be required to clarify, confirm and obtain additional information to accurately file your return.

Please schedule your interview below. It is imperative that you select a time when you will be available, uninterrupted for 30 minutes. Please come prepared with any questions and/or additional information you want to include in your return.
Appointment
By submitting this application, I understand and consent to providing my personal information, including but not limited to my full name, date of birth, social security number, and banking information. I acknowledge that this information is necessary for verification purposes, to grant me access to the software, and to ensure that I receive payment upon the funding of tax returns. I agree to the use of my personal information for these purposes and confirm that all information provided is accurate and up-to-date.

Do you agree to the terms outlines above?
Date Signed

MonthDayYear
Date
Taxpayer Signature

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Date Signed

MonthDayYear
Date
Spouse Signature

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