✨Xclusive Tax Preparation Client✨ Intake Form 2025

✨Xclusive Tax Preparation Client✨ Intake Form 2025

Thank you for trusting me with your tax needs. My name is Lakee Banda, owner of XTC, with over 8 years of experience providing professional and reliable tax preparation services. I’m honored to serve you and committed to making this tax season smooth, stress-free, and rewarding. From maximizing your refund to answering any questions, I’m here every step of the way. If you need assistance, feel free to contact me directly at 770-568-2798. Thank you for choosing Xclusive Tax Consulting Services—let’s make this a successful tax season! Lakee Banda
PLEASE ALLOW ME 2-3 BUSINESS DAYS TO PROCESS YOUR TAX FILING THANK YOU!!!!
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower
Did you file 2024 Taxes?
Did you receive a Tax Refund?
Do you receive EBT or Snap benefits *
Are you on Housing assistance or Section 8? *
Receiving EBT/SNAP, Housing Assistance, or Section 8 does NOT automatically disqualify you from filing Head of Household.

BUT the IRS requires that you personally pay MORE than 50% of the household expenses.

Government assistance does NOT count as money you paid out of pocket.

Every situation is different — this is why filing correctly matters.
Who referred you?
NEW CLIENTS YOU MUST UPLOAD 2023 & 2024 Tax Returns!!! No exceptions!!!
Upload 2023 Taxes

Cancelof
Upload 2024 Taxes

Cancelof
Enter IP PIN
Upload Driver License or ID *

Cancelof

Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Upload Birth certificate

Cancelof
Add Social Security Number *
Upload Social security card

Cancelof
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Add Routing
Add Account
Name of Bank
Upload Banking Account & Routing Number

Cancelof
Upload Lease or Utility Bill

Cancelof
Occupation
Upload W-2 or 1099

Cancelof
Upload Additional Documents

Cancelof
Are you a full-time student?

YesNo
Upload 1098-T

Cancelof
Are you totally and permanently disabled?

YesNo
Are you legally blind?

YesNo

Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Add Social security number
Upload Social security card

Cancelof
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Upload W-2 or 1099

Cancelof
Upload additional documents

Cancelof
Are they a full-time student?

YesNo
Upload 1098-T

Cancelof
Are they totally and permanently disabled?

YesNo
Are they legally blind?

YesNo
Are they your dependent?

YesNo

Enter your dependents here

	Name	Date of Birth	Relationship	SSN
1
2
3
4
5
6

Upload Social security cards

Cancelof

Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?

	Yes/No	Employer	Spouse Ins	Exchange/ Marketplace	Direct with Insurer	Medicare	Medicaid
Taxpayer
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Do you have Market Place Insurance?
Upload 1095 A Market Place Form

Cancelof
Upload additional documents

Cancelof

Please fill-up the information within the current year only.

General Business Expenses

	Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses

Total Expenses
Upload additional documents

Cancelof
Additional comments

I confirm that all the information I have entered here is accurate and true.

• I allow Xclusive Tax Consulting to capture my sensitive data, including personal identification, government-issued identification, and other relevant information.

• I have read and agree to the terms and conditions and privacy policy of Xclusive Tax Consulting.

• By signing below, I acknowledge that I have read, understood, and accept my responsibilities and those of Xclusive Tax Consulting in completing this tax return.

Contact Information

Phone: 770-568-2788

Email: xclusivetaxconsulting@aol.com
Date Signed

MonthDayYear
Date
Taxpayer Signature*

Powered by Jotform SignClear
Spouse Signature

Powered by Jotform SignClear
Date Signed

MonthDayYear
Date
Please allow 2-3 days for the completion of your taxes, as I do have other clients ahead of you. I appreciate your patience and understanding. Thank you for trusting Xclusive Tax Consulting with your tax needs!
Should be Empty: