Client Intake Form
Thank you for choosing us as your trusted tax partner.
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SSN
Enter SSN without dashes please
Occupation
Did someone refer you?
Their name and number please or social media
Who do you prefer as your tax specialist or would like someone to be assigned to you?
Please Select
FAIRA (SJ TAX LADY)
ANGELA (BNB TAX PROS)
KECIA
SNETHIA
SAMARIA
TISHA (BNB TAX PROS)
TIERRA
RONNIE
ALAINA
If no preparer is selected then one will be assigned for you.
Who do you prefer as your tax specialist or would like someone to be assigned to you?
Are you applying for a tax advance loan?
Yes
No
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Are you legally blind?
Yes
No
Spouse Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
SSN
Enter SSN without dashes please
Occupation
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they legally blind?
Yes
No
Are they your dependent?
Yes
No
Dependents
Enter your dependents here
Rows
Name
Date of Birth
Relationship
SSN
1
2
3
4
5
6
Do you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
Rows
Yes/No
Employer
Spouse Ins
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Tax Related Questions
Do you owe the IRS?
Yes
No
If yes, please provide details here:
Please include, how much you owe, what tax year(s), and if you are on a payment plan
Did you receive a federal tax refund last year?
Yes
No
If yes, how much was your refund last year?
Do you have your 1040 from last years return? If yes, please upload at the end of this form. If no, please request your 1040 from previous preparer if possible.
Yes
No
Employment Status
Employed
Unemployed
Self-employed
Are you contributing to a retirement account (ie. 401K, Traditional IRA, Roth IRA) ?
Yes
No
Do you or your dependent(s) have tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
If yes, please list child care expenses here (Provider name, total amount and EIN if available) :
Do you have energy star rated improvements to your home?
Windows
Doors
Furnace
Other
How long have you lived at the property?
# of months
Do you own a home?
Yes
No
Did you pay property taxes?
Yes
No
If yes, please list amount and address associated with payment(s):
Include taxes on both real property and personal property. Personal property includes things like vehicles, boats, and other movable assets.
Did you make any any investments? (Real estate, stock, crypto, art, etc)
Yes
No
If yes please list details of investments here(amount/date/earned income)**more information may be requested:
Did you take money from your retirement account (401K, Traditional IRA, Roth IRA)?
Yes
No
If yes, how much? Did you receive tax document for the withdrawal? What was the money used for?
Are you a victim of identity theft?
Yes
No
If yes, please provide more information here. Did you notify the IRS? Do you have an IP PIN?
Expenses
Please only fill out the information within the current tax year (2024).
General Personal Expenses
Rows
Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage Interest
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses
Total Personal Expenses
Additional comments:
Please include anything you would like us to know about your past or current tax situation.
Documents
Please upload a copy of you and your spouse's ID, and any tax forms or supporting documents (w2(s), 1099(s), 1095(s), receipts, etc.)
Browse Files
Drag and drop files here
Choose a file
If you have any dependents, birth certificate(s) and/or social security card(s) are needed**
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Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow FK and Co. Tax Pros to capture my sensitive data like government ID, and other information.
I have read the terms and conditions and privacy policy of FK and Co. Tax Pros
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Tax Payer Signature
*
Date Signed
*
-
Month
-
Day
Year
Date
Spouse's Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
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