Exceptional Taxes Client Intake Form

Welcome to Exceptional Tax & Consulting, where your financial success is our top priority! We understand that managing finances and taxes can sometimes feel overwhelming. That's why we've developed this user-friendly intake form, designed to make your experience with us as seamless and efficient as possible.

At Exceptional Tax & Consulting, we take pride in delivering personalized and accurate financial solutions for our clients. This intake form is a vital first step in providing you with exceptional service. Our team of dedicated experts are committed to working closely with you, ensuring that the information you provide helps us tailor our services to meet your unique needs and financial goals.

Your trust in Exceptional Tax & Consulting is greatly valued, and we are dedicated to maintaining the confidentiality and security of all the information you share. Thank you for choosing us as your financial partner. We look forward to serving you with excellence and precision, helping you achieve financial success and peace of mind.

Client Intake Form

Please fill in the form below.
Tax Filing Year
Filing Status
Your Full Name

First NameLast Name
Your Phone Number

Area CodePhone Number
Your E-mail
Tax Payers Social Security Number
Tax Payers Date of Birth

YearMonthDay
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide the name of the person who referred you or provide the place where you saw our business.
Did you receive health insurance through the Market Place?
Your Occupation
Did you work in different states this tax season?
If so, Please provide the following 1. States you worked in 2. Timeframe you worked in those states
Have you ever been audited by the IRS?
If so, Please provide the year/s of audit and what were the outcomes of the audits
Primary Taxpayer - Please Check Any That Apply
Spouse Information

If no spouse, please skip.
Spouse's Name

First NameLast Name
Spouse's Date of Birth

YearMonthDay
Date
Spouse's Social Security Number
Spouse's Occupation
Spouse's Email Address
example@example.com
Spouse - Please Check Any That Apply
Dependent Information

The Earned Income Credit (EIC) increases with the first 3 Children you claim. The maximum number of dependents you can claim for Earned Income Purposes is Three. You MUST also meet other requirements related to your Adjusted Gross Income (AGI) to qualify for EIC. If you are MARRIED and FILING SEPARATE you CAN'T claim the credit.

Dependent Information

Rows	Name	Date of Birth	Social Security Number	Full Time Student? Yes or No	Disabled? Yes or No?	How Many Months Did The Child Live In Your Home?	Relationship To The Dependent
1st Dependent
2nd Dependent
3rd Dependent
4th Dependent
5th Dependent
6th Dependent

IP (Identity Protection) Pin

Rows	Name	IP Pin
Taxpayer
Spouse
1st Dependent
2nd Dependent
3rd Dependent
4th Dependent
5th Dependent
6th Dependent

Business Information

Please complete if you are self employed.
Are you self employed or a business owner?
If so what kind of business do you have?
Please provide your business EIN Number
How long have you been in business?
Business Adress

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Upload Copy Of Your Previous Year Tax Return Including Schedule C If You Filed Self Employment

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Please upload your profit/expense records.

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Did you have a vehicle you used for your business?
If so, list the year make and model of the vehicle.
Do you have a separate personal vehicle?
College Student Information

Please complete if anyone in your household went to college.
Did Anyone Listed On This Return Attend College this Tax Season
If so - please upload form 1098-T and other college related documents below.

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Name(s) of the person who attended college
Did all students attend at least half time?
Were they seeking a degree?
How much money was spent on other books or materials in relation to college?
How many tax years have you claimed the American Opportunity Tax Credit?
Was the student ever charged with drug related felonies?
Are You Currently Paying Student Loans?
If so please upload your Form 1098-E - Student loan Interest

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Upload Requested Documents

PLEASE NOTE: YOU CAN UPLOAD MULTIPLE DOCUMENTS
Upload ID/DL (for anyone over 18 years old on this filing)

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Please upload a copy of utility bill

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Upload Social Security Card (for all listed on this filing)

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Please upload all W2's HERE - You can upload multiple files

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If you received Unemployment Please Provide 1099-G form

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Withdrawal out of 401K? Please attach documentation if available.

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Please provide Mortgage / Property Tax form(s) if paid taxes / insurance

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Please Upload any Additional Tax Forms that you have Received.

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Please upload Birth Certificates for all dependents.

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Banking Information
Do you owe or have you owed the IRS?
Will you want any of the following Bank Products? (Choose All That Apply ) ** Please note all bank products must go through an approval process and will require a written authorization Form 7216 Bank Consent to Disclosure of Tax Return Information
Signature Consenting to Form 7216 Bank Consent to Disclosure of Tax Return Information
How would you like your refund to be deposited when ready?
Bank Name
Is this a Checking or Savings account?
Routing Number
Confirm Routing Number
Account Number
Confirm Account Number
Due Diligence Questions
Have you ever been disallowed the Earned Income tax Credit, The additional child Tax credit, or the Child tax credit?
If you are a single parent, Where's the other parents of your child/children?
What is the name of the other parent(s)
Why is the other parent not claiming the child?
If you are divorced or separated, when did you last live in the same home?
Do you have joint custody of your child? (If so which child/children)
How long did your child/children live in the other parent's home during the tax year? (in months)
Do you have a signed form 8332 granting the right to claim this child/children?
Did anyone else live in the home that provides financial support for your child/dependents?
Can or could anyone else be eligible to claim this dependent on their tax return?
Did you pay someone to watch your child/children?
If so please upload any childcare statements.

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Did you receive any type of supplemental, non taxable income such as child support, Welfare benefits, Social security, etc?
Are there other people living in the home not reported on the tax return? if so, what are their names and how much do they earn?
Signatures

Please Review & Sign Consent Forms
Signature Consenting to Client Engagement Letter
Signature Consenting to Consent To Use Of Tax Return Information
Signature Consenting to Consent To File Tax Return Electronically
By Typing Your Name, Signature & Date you agree that everything entered on this form is true and correct.

- I have confirmed that all information I entered here is accurate and true.

- I allow Exceptional Tax & Consulting to capture my sensitive data like personal ID, government ID, social security number (SSN), and other information.

- By typing your name below, and signing your signature you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Type Your Name

First NameLast Name
Signature
Today's Date:

YearMonthDay
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