Client Intake Form

Client Intake Form
Taxpayer Information
SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow(er) with Dependent Children
Taxpayer Name*

First NameLast Name
Taxpayer Date of Birth*

MonthDayYear
Date
Taxpayer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer Phone Number*
Taxpayer Email Address*
example@example.com
T-MobileVerizonAT&TSprintMetro PCBoost MobileOther
Taxpayer SSN*
Taxpayer Occupation*
Please upload a clear picture of your ID

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Please upload a clear picture of your Social Security Card

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Spouse Information
Spouse Name

First NameLast Name
Spouse Date of Birth

MonthDayYear
Date
Spouse Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse Email Address
example@example.com
Spouse Phone Number
Spouse Occupation
Spouse SSN
Please upload Spouse ID

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Please Upload Spouse Social Security Card

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2024202320222021Other
Do you have a copy of your previous tax return (if filed)?*
Have you received any letters in the mail from the IRS within the last 12 months?*
Dependent Information

Enter your dependents

Rows	FULL DEPENDENT NAME	DATE OF BIRTH	# OF MONTHS DEPENDENT RESIDE WITH TAXPAYER	SOCIAL SECURITY NUMBER
DEPENDENT 1
DEPENDENT 2
DEPENDENT 3
DEPENDENT 4
DEPENDENT 5

Please Upload Dependents Social Security Card

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Please Upload Dependents Birth Certificate

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HEALTH INSURANCE COVERAGE:
DID YOU RECEIVED HEALTH COVERAGE (INSURANCE) THROUGH YOUR STATE MARKETPLACE OR HEALTHCARE.GOV? IF SO, PLEASE UPLOAD YOUR FORM 1095A
Please upload 1095A

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Tax Related Questions
Are you a full-time student?*
Are you totally and permanently disabled?*
Are you legally blind?*
Can you be claimed as a dependent on another tax return?*
Do you have any expenses for child care?*
Are any of your dependents in college?*
Do your dependents have tuition expenses?*
Did you sell or exchange any virtual currency?*
Did you take money from your 401K?*
Do you have mortgage interest?*
Did you pay for vehicle tax*
Are you a victim of identity theft with the IRS?*
Do you have documents that shows you paid for property taxes?*
Did you receive a federal tax refund last year?*
Expenses

General Expenses

Rows	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

Wages and Salaries (Attach W-2's)

Interest Income (Attach 1099's) (List and identify as non-taxable Interest Income)

Unemployment Compensation Received (FORM 1099G) PLEASE UPLOAD FORM BELOW:
File Upload

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Were you, your spouse, or any dependent registered in college? Do you have a form 1098T?
File Upload

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Refund
Personal CheckingsPersonal SavingsBusiness CheckingsBusiness SavingsOther
Name(s) on bank account*
Bank Name*
Your Account Number*
Bank Routing Number*
YesNoN/A
CheckDirect DepositPre-Paid CardOther
If owed a federal tax refund, are you interested in applying for a Refund Advance Loan?*
Business Income & Expenses (Sole Proprietorship, LLC)
Owner Name

First NameLast Name
Business name
Employer ID number
Business Type
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer ID number (EIN)
YesNo
Estimated percentage of time spent in home office compared to total time spent in this business
Estimated of time in home office compared to total time in this business
Description of work done in home office
Description of work done outside of work office
Total area of home
Total area of home used regularly for business
Please upload any additional tax documents below:

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Are you interested in receiving Audit Protection for current year tax return?*
Does anyone listed on the Tax Return have an 6 digit Identity Pin? If so, please list the name and Identity Pin below:
Jennifer TurnerKimberly WhatleyBranika Pride
How did you hear about us?*
If you were referred by someone, please provide their information below. First and Last name, email address and or phone number
Thank you for entrusting Elite Tax Consultants with your tax preparation needs. As we prepare to finalize your tax return, it's essential to ensure mutual understanding of responsibilities and the accuracy of the information provided. By the signing below you acknowledge, you have reviewed all the information provided and confirm that it is complete and accurate to the best of your knowledge. You authorize Elite Tax Consultants to file your tax return on your behalf.
Date*

MonthDayYear
Date
Signature*
Should be Empty:

Client Intake Form

Taxpayer Information

Spouse Information

Dependent Information

HEALTH INSURANCE COVERAGE:

Tax Related Questions

Expenses

Refund