Client Intake Form

CLIENT INTAKE FORM
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.
Name of Tax Preparer
How did you hear about us?
If someone referred you, please type his or her name here.
If you are filing multiple years you must complete a separate form for each year.
Which Tax Year Are You Filing For?
Will this be an amended (corrected) return?*

YesNo
Are you interested in a tax advance loan?*

YesNo

GENERAL INFORMATION
Taxpayer's Name*

First NameLast Name
Taxpayer's Social Security Number*

Area CodePhone Number
Social Security Number*
9 Digit Social Security Number
Taxpayer's Date of Birth*

MonthDayYear
Date
Taxpayer's Job Title*
Taxpayer's Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer's Email Address*
example@example.com
What is your marital status as of December 31st?*

SingleMarriedDivorcedSeparatedSurviving Spouse
Taxpayer's Driver's License/ State ID (Stand directly over the item on a flat surface and zoom in for a clear shot)*

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Taxpayer's Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Were you previously issues an Identity Protection Pin (IPPIN) by the IRS?
IPPIN IDENTITY THEFT IF (APPLICABLE) (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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Can someone else claim you as a dependent?*
What is the Name of person that can claim you?
What is your relationship to that person? (I.e. Mother, Father, etc.)
How much support did they provide for you?
Do you owe the IRS, Child Support or in default with student loans?*
Have you ever been disallowed for EITC/AOTC/CTC/ACTC?*
Are you self employed?*
Did you buy or trade Crypto Currency? (Bitcoin)
Which currency did you buy or trade?
How much currency did you buy or trade?
Do you have gambling winnings for the year?*
Where are your winnings from?
How much did you win?
Upload W2-G Section*

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Did you make any charitable contributions during the year?
Who did you make charitable contributions to?
How much did you contribute?
Did you withdraw from your 401K during the year ?
How much did you withdraw?
How much Federal taxes were withheld?

INCOME
Upload W2 statements (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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1099 NEC (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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Did you receive unemployment during the year?
Upload other Misc. Income Documents such as 1099 INT, 1099 DIV, 1099 NEC. (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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CURRENT LIVING SITUATION
Do you receive Subsidized Housing or Section 8?
Do you receive any Government Assistance Programs such as Food stamps, TANF, Medicaid, or Medicare in during the year?
Which program(s) did you receive?
How much did you receive from the program(s).
Do you have a 1098 Mortgage Interest Statement?
Was your insurance through the Affordable Care Act (The Marketplace), current employer, or state?*

The MarketplaceEmployerStateNo insurance
Do you have 1095A, 1095B, or 1095C form?

YesNo
PLEASE UPLOAD YOUR 1095 Form IF APPLICABLE (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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Did anyone in your household attend college for the selected tax year?*
What was the Name of the person who attended college?
What was the name of the college they attended?
Form 1098-T (School Credit) *Stand directly over the item on a flat surface and zoom in for a clear shot.

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DEPENDENT'S INFORMATION
Are you claiming any dependents on your tax return?*
How many dependents are you claiming?*
(8812 CTC) Did you receive monthly IRS Advance Tax Credit payments?
Please Upload IRS Forms 6419 Advanced Child Tax Credit Payment Received for Children (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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ACKNOWLEDGMENT & SIGNATURE
Are you interested in Audit Protection? (Mandatory For ALL Schedule C'S)
Are you interested in Credit Repair?
STOP!

Did you finish uploading your documents?

IF YOU DID NOT UPLOAD ALL NECESSARY DOCUMENTS YOUR INTAKE FORM WILL BE VOIDED.
If your refund is offset by the IRS, student loans, child support or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return.

By signing this agreement you acknowledge that if payment is not made in full within 30 days legal actions will be sought to resolve payment.
How would you like you refund disbursed if receiving on?*

Direct DepositCheckBy MailN/A
Name of Bank
Routing Number
Bank Account Number
Primary Taxpayer's Signature*

Clear
Taxpayer's Signature

Clear
Date*

MonthDayYear
Date
BEFORE YOU SUBMIT GO BACK AND REVIEW

Make sure you have uploaded current and valid documents. If we find that you are missing documents or documents are not valid, we will place your return on hold and WILL NOT EFILE until we receive the proper documents.
Should be Empty:

CLIENT INTAKE FORM

STOP!

Did you finish uploading your documents?

IF YOU DID NOT UPLOAD ALL NECESSARY DOCUMENTS YOUR INTAKE FORM WILL BE VOIDED.

BEFORE YOU SUBMIT GO BACK AND REVIEW