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*
Please provide the name of the person who referred you or provide the place where you saw our business.
Filing Status*

Head of HouseholdSingleMarried Filing JointlyMarried Filing SeparateQualifying Widow With Dependent
Your Full Name*

PrefixFirst 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
Did you receive health insurance through the Market Place?*

YesNo
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

Taxpayer can be claimed as a dependent on someone else's return.Taxpayer was over age 18 and a full-time student at an eligible educational institution.Taxpayer is blind.Taxpayer is deceased.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.Taxpayer is disabled.
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

Spouse can be claimed as a dependent on someone else's return.Spouse was over age 18 and a full-time student at an eligible educational institution.Spouse is blind.Spouse is deceased.Spouse has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.Spouse prefers to receive written communications from the IRS in a language other than English.Spouse prefers to receive written communications from the IRS in an accessible format.Spouse is disabled.
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

	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

	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?*

YesNo
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?

YesNo
If so, list the year make and model of the vehicle.
Do you have a separate personal vehicle?

YesNo
College Student Information

Please complete if anyone in your household went to college.
Did Anyone Listed On This Return Attend College this Tax Season*

YesNo
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?

YesNo
Were they seeking a degree?

YesNo
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?

YesNo
Are You Currently Paying Student Loans?

YesNo
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?*

YesNo
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*

No Bank ProductsTax Refund AdvancesDeduct Tax Preparation Fee from your Refund
Signature Consenting to Form 7216 Bank Consent to Disclosure of Tax Return Information*

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How would you like your refund to be deposited when ready?*

Check from IRSDirect DepositPre-Paid Debit CardI have a Tax Obligation and will not be receiving a refund
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?*

YesNo
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?*

YesNoNot NeededNot Applicable
Did anyone else live in the home that provides financial support for your child/dependents?*

YesNoNot Applicable
Can or could anyone else be eligible to claim this dependent on their tax return?
Did you pay someone to watch your child/children?*

YesNoNot Applicable
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?*

YesNo
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*

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Signature Consenting to Consent To Use Of Tax Return Information*

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Signature Consenting to Consent To File Tax Return Electronically*

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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*

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Today's Date:*

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