Himadri Das Client Intake Form

CLIENT INTAKE FORM
How did you hear about us?
Are you interested in Bookkeeping?
If someone referred you, please type his or her name here.
TaxPayer's Name

First NameLast Name
Taxpayer's Phone Number
Example: xxx-xxx-xxxx
Taxpayer's Job Title
Taxpayer's Date of Birth
Example: mm/dd/yyyy
Taxpayer's SSN
Example: xxx-xx-xxxx
Taxpayer's Email Address
example@example.com
Spouse's Full Name
First Name
Spouse's SSN
Example: xxx-xx-xxxx
Spouce's Date of Birth
Example: mm/dd/yyyy
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Job Title
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you self employed?
Did you and your spouse live together during the whole year?
What is your marital status as of December
Did you pay over half the expenses maintaining your residence for the entire year?
Did you support a child or family member for more than 6 months out of the year?
Are you on any Government Assistance
How many dependents are you claiming?
Dependent #1

First NameLast Name
Dependent #1 Date of Birth
mm/dd/yyyy
Dependent #1 SSN
What is Dependent #1's Relationship to you (son, daughter, etc.)?
How many months did Dependent #1 live with you this year? (If all year, enter 12)
Are there any dependents in daycare? If Daycare, Then upload the form you received from your daycare provider.
Upload a copy of your daycare form here.

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How would you like to receive your tax refund?

Other
Which type of account would you like your refund deposited into?

Other
Name of Bank
Routing Number
Bank Account Number
Can someone else claim you as a dependent?
Did you have health insurance during the whole year?
Did you have health insurance for the entire year?
Who was your insurance cover through this year??
Was YOUR DEPENDENTS' insurance through your employer?
Who was your Dependents insured with this year??
Was your insurance through your employer?
Have you ever been denied the Earned Tax Credit (EITC)?
Were you or any of your dependents in college this year??
Did you trade any Virtual Currency
Are you interested in AUDIT PROTECTION?
Do you have a 1098-T Form for either you or your dependents?
Upload Taxpayer & Dependent(s) Insurance Documents

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If you have a 1098-T form, upload it here.

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Taxpayer's Driver's License

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Taxpayer's and Dependent(s ) Social Security Card(s)

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Taxpayer's W-2/ 1099'S

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Spouse's W-2/ 1099'S

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Attention Business Owners
I have attached or included with this form all W2s, 1099s, a copy of my identification and social security card if available as well as all other documents that are relevant to preparing my taxes.

I understand and agree that I will receive an email, call or text notification within 24 hours notifying me of my expected Federal & State Tax Outcome or an update if not completed.
Primary Taxpayer's Signature
Date

MonthDayYear
Spouse's Signature (If no spouse, leave blank)
Date

MonthDayYear
Should be Empty:

CLIENT INTAKE FORM

Attention Business Owners