CLIENT INTAKE FORM
Kindly Fill This Form Out So We Can Assist You Better
How did you hear about us?
Facebook
Instagram
Referral
Previous Client
Tax Preparer Name
If someone referred you, please type his or her name here.
Are you looking to purchase a new home within the next 2 years?
Yes
No
Taxpayer Name
First Name
Last Name
Taxpayer Phone Number
*
Example: xxx-xxx-xxxx
Taxpayer Job Title
Taxpayer Date of Birth
*
Example: 01/01/2001
Taxpayer SSN
Example: xxx-xx-xxxx
Taxpayer Email Address
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Spouse Full Name
First Name
Last Name
Spouse Date of Birth
Example: 01/01/2001
Spouse SSN
Example: xxx-xx-xxxx
Spouse Phone Number
Example: xxx-xxx-xxxx
Spouse Email Address
Example: example@example.com
Taxpayer SSN
Example: xxx-xx-xxxx
Spouse Job Title
What is your marital status as of December 2025
*
Single (never married)
Married
Married not living with spouse
Are you self-employed?
*
Yes
No
Are you a household employee?
Yes
No
Did you and your spouse live apart during the year?
*
Yes
No
Not Applicable
Did you pay over half the expenses of maintaining your residence for the entire year?
*
Yes
No
Did you support a child(ren) or family member for more than 6 months out of the year?
*
Yes
No
If yes, did you live together at any time after June 30, 2024?
*
Yes
No
Not Applicable
Are you on any Government Assistance
*
Yes
No
Not Applicable
How many dependents are you claiming?
*
Please Select
0
1
2
3
4
5
Dependent #1
First Name
Last Name
Dependent #1 Date of Birth
01/01/2001
Dependent #1 SSN
What is dependent #1 relationship to you (son, daughter, etc.)?
How many months did dependent #1 live with you in 2025? (If all year, enter 12)
Dependent #2
First Name
Last Name
Dependent #2 Date of Birth
Example: 01/01/2001
Dependent #2 SSN
How many months did dependent #2 live with you in 2025? (If all year, enter 12)
What is dependent #2 relationship to you (son, daughter, etc.)?
Dependent #3
First Name
Last Name
Dependent #3 Date of Birth
01/01/2001
How many months did dependent #3 live with you in 2025? (If all year, enter 12)
Dependent #3 SSN
Example: xxx-xx-xxxx
Dependent #3 SSN
What is Dependent #3 Relationship to you (son, daughter, etc.)?
Dependent #4 First Name
First Name
Dependent #4 Last Name
Last Name
Dependent #4 Date of Birth
01/01/2001
Dependent #4 SSN
Example: xxx-xx-xxxx
What is dependent #4 relationship to you (son, daughter, etc.)?
How many months did dependent #4 live with you in 2024? (If all year, enter 12)
Dependent #5 First Name
First Name
Dependent #5 Last Name
Last Name
Dependent #5 Date of Birth
01/01/2001
Dependent #5 SSN
Example: xxx-xx-xxxx
What is Dependent #5 relationship to you (son, daughter, etc.)?
How many months did Dependent #5 live with you in 2025? (If all year, enter 12)
Did you pay a daycare provider or an individual to care for your dependent(s) while you worked, looked for employment or attended school in 2025? If yes, please upload the form or letter you received.
Yes
No
How would you like to receive your tax refund?
Checks
Direct Deposit
FasterMoney Visa Card
Name of Bank
Which type of account would you like your refund deposited into?
Checking Account
Savings Account
Other
Routing Number
Bank Account Number
Can someone else claim you or your dependent(s) as a dependent on their tax return?
Yes
No
Did you, your spouse, or dependent(s) have health insurance under the Affordable Care Act, also known as Obama Care, Healthcare.gov, or Marketplace in 2025?
Yes
No
Who was your insurance coverage through in 2025?
Please Select
The Marketplace
Employer
Medicaid
Was your insurance through Medicaid?
Yes
No
Was your insurance through the Affordable Care Act (The Marketplace)?
Yes
No
Did your dependents have health insurance for the entire year?
Yes
No
Not Appliable
Was YOUR DEPENDENTS' insurance through Medicaid?
Yes
No
Not Applicable
Was YOUR DEPENDENTS' insurance through the Affordable Care Act (The Marketplace)?
Yes
No
Not Applicable
Have you ever been denied or credits were reduced in prior tax years for Earned Income Tax Credit (EITC), Child Tax Credit (CTC), Additional Child Tax Credit (ACTC) Head of Household (HOH) filing status, or any other credits?
Yes
No
Did you or your dependent(s) attend college in 2025?
Yes
No
Did you receive a 1098-T form for tax year 2025?
Yes
No
Do you have a 1098-T Form for either you or your dependent(s)?
Yes
No
Are you interested in Audit Protection?
Yes
No
Taxpayer's Signature
Date
-
Month
-
Day
Year
Date
Spouse's Signature (If no spouse, leave blank)
Date
-
Month
-
Day
Year
Date
Type a question
Date
-
Month
-
Day
Year
Date
Upload Taxpayer's Driver's License or Identification Card. If expired, you will not be serviced until it is valid.
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Upload Taxpayer and Dependent(s) Social Security Cards
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Upload Taxpayer and Dependent(s) Birth Certificates
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Upload Taxpayer W-2/1099'S
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Upload Proof of Residency (Lease/Utility Bill)
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Upload Daycare Statement or Child Care Letter
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Submit
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