Tax Client Intake Form

Tax Client Intake Form
Name

First NameMiddle NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
Birthdate:

MonthDayYear
Date
Social Security Number:
Occupation Title
Spouse Full Name: (If Filing together)

First NameLast Name
Spouse Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Spouse Occupation:
Dependent Information

Enter each Dependents Name, Social Security Number, Date of Birth and Relationship
Dependent 1
Dependent 2
Dependent 3
Dependent 4
If any of your dependents are disabled list them here:
Type a question
Are you disabled?
Select your filing status:
Were you audited by the IRS last year?
Did you receive Marketplace Insurance?
Do you have an IP PIN?
Do you have any credits that were disallowed or reduced?
If you have any credits that were disallowed or reduced, please list them here.
2023 Identity Protection Pin & who it was issued to.
Please upload proof of residency for each dependency.

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If you are filing Head of Household, what documents will you provide for proof of Head of Household?
Please upload proof of Head of Household, if applicable.

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Please upload your Drivers license/ID. If you are filing with Spouse upload theirs as well.

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Please answer only if it applies to you.
If your address is different than the one thats on your government ID or drivers license, please indicate the reason why.
If applicable, please explain why you are claiming a dependent who is not related to you. What are the circumstances under which you supported this dependent for at least six months of 2023? Please outline the support you provided to this dependent.
Are all the dependents you are claiming related to you by birth or bloodline? If not, please specify which child is not related to you.
Please answer if applicable: If your last name is different from your dependents' last names that you are filing, what is the reason for the difference? Please provide an explanation for why your last name and your dependents' last names are not the same.
Please answer only if applicable: If your income is at or below $13,000.00 and you have two or more children, how are you able to maintain your household? For example, did you receive government assistance such as Section 8, public housing, SNAP benefits, or other support?
If you are the father of the child and claiming the child. Please indicate the reason why the child is living with you and not the mother. Please outline the support you have provided to the child.
Federal Financial Documents
Financial Tax Documents (W2,1099,Unemployment,ect)

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If you received a 1099G form for unemployment, please upload it here.

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If you received a 1098T form for school, please upload here

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Do you need assistance with organizing your/side hustle business income & expenses?
Did you have a business in 2023? This includes 1099s or side businesses, such as hair braiding, hairstyling, babysitting, Uber, Lyft, DoorDash, etc. If so, what is the name and nature of your business or side hustle? If you don't have a name, you can skip that par
Did you purchase a vehicle recently?
If yes, please list the year make and model of the vehicle.
Other Documents

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Do you want to apply for a cash advance of up to $7,000? No credit check required. You will be notified of approval within 24 hours.
How do you want to receive your refund?
If you selected Direct Deposit, please enter your information below
Bank Name
Account Number
Confirm Account Number
Routing Number
Confirm Routing Number
Tax Form Abandonment/ ACH Agreement
Here at JWells & Co. Unfulfilled Tax Quotes will result in a $150 Service Fee - If the client decides to file their tax return elsewhere. This fee will be processed through our payment merchant until fulfilled. If the client files their taxes with us, they will be charged the regular tax filing fees processed from the tax return per usual. No upfront fees - all fees will be cured from the tax return unless otherwise agreed due to intricate tax situations. Thank you - JWells & Co.
JWells & Company Consulting, LLC
will prepare your 2023 individual tax return from the information you furnished to us. You, the taxpayer, are ultimately responsible for the preparation and filing of your tax return. I, the Taxpayer named above, have provided to JWells & Company Business Consulting, LLC the attached tax information and to the best of my knowledge this information is true, correct, and complete.
Tax Payer Signature (Must be Legible):
Spouse Signature (if applicable):
Notes (anything you think we need to know :)
Should be Empty:

Tax Client Intake Form

Dependent Information

Please answer only if it applies to you.

Federal Financial Documents

If you selected Direct Deposit, please enter your information below

Tax Form Abandonment/ ACH Agreement

JWells & Company Consulting, LLC