Speedy Tax Services Inc.
Info@speedytaxinc.net
312-678-2816
www.speedytaxinc.net
Tax Preparation Client Intake Form
Taxpayer Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
*
Social:
*
Do You have an IPIN? If Yes, Please provide number. If “NO” type (N/A)
*
How Did you Hear about us? (Facebook, Instagram, Please write Persons name)
Self-Employed Information
Name of Business
Business Address
Business Industry
Business EIN
Is this business Cash Only?
Yes
No
Are you a full-time student?
Yes
No
Do you Owe the IRS?
Yes
No
Do You have a 1095-A Market Place Form?
Yes
No
Spouse Information
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Occupation
Social
Are they a full-time student?
Yes
No
Do You owe the IRS?
Yes
No
Dependents
Enter your dependents here
Name
Date of Birth
Relationship
Social
1
2
3
4
5
6
Do you have any expenses for child care?
Yes
No
Do you own your home?
Yes
No
Did you receive a federal tax last year?
Yes
No
Upload Tax Documents
Please upload your Tax Documents Here: ( W2s, 1099s, Mortgage Statement. ETC))
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please upload your Unexpired Drivers License or State ID
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please upload your Market Place Insurance if Applicable (1095-A or 1095-B)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow Speedy Tax Services to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of Speedy Tax Services.
I understand if I am receiving a Tax Advance I am responsible to pay it back in full
I have uploaded all of the REQUIRED documents.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed
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Month
-
Day
Year
Date
Taxpayer Signature
Date Signed
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Month
-
Day
Year
Date
Spouse Signature
Submit
Submit
Submit
Tax Related Questions
Should be Empty: