CLIENT INTAKE FORM

CLIENT INTAKE FORM

(To Be Completed Before Tax Preparer E-File Your Tax Return)
Please complete this form in its entirety. Upload all documents at the end of the form.
Who will E-File your Tax Return?
Which Tax Year(s) Are You Filing?
Is it your 1st time filing with PL Financial?
Who Referred you to PL Financial?
Taxpayer's Name

First NameLast Name
Middle Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
Taxpayer's Date of Birth

MonthDayYear
Date
Taxpayer's Phone Number
Please enter a valid phone number.
Taxpayer's Social Security Number
Taxpayer's Job Title
Are you Married?
What is your filing status?

Single (Not Married)Married Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Surviving SpouseNonresident Alien
Spouse (If Married Filing Jointly)

First NameLast Name
Were you previously issues an Identity Protection Pin (IP PIN) by the IRS?

YESNO
Enter your IP PIN (if you have)
Are you Self employed?

YESNO
Business Name:
EIN or Tax ID Number
Dependent Information

If dependent(s) are disabled, letter documentation will be required by IRS
Do you have dependents to claim on your 2024 tax return?

YESNO
Name(Dependent #1)

First NameLast Name
Middle Name
Age
Date of Birth

MonthDayYear
Date
Social Security Number
Relationship to Tax Payer
Name (Dependent #2)

First NameLast Name
Middle Name
Age
Date of Birth

MonthDayYear
Date
Social Security Number
Relationship to Tax Payer
Name (Dependent #3)

First NameLast Name
Middle Name
Age
Date of Birth

MonthDayYear
Date
Social Security Number
Relationship to Tax Payer
How many months did the dependent stay with you in the current filing year?
Can anyone else claim dependent(s)
Do you owe the IRS, Child Support or in default with student loans?

YESNO
How would you like to receive your tax refund?

Bank Cashier's Check (Only available for in office visits)Direct Deposit
If Direct Deposit, which type of account would you like your refund depositedinto?

Checking AccountSavings AccountOthers
Taxpayer's Routing Number
Taxpayer's Bank Account Number
Bank Information:
Taxpayer's Email Address
example@example.com
Are you interested in Audit Protection? (Mandatory For ALL Schedule C'S)

YESNO
Are you interested in Credit Repair?

YESNO
Please upload ID or Drivers License

Cancelof
Please upload supporting business documents. (ex P&L, 1099 NEC, Summary of Income, Spread sheet with expenses). (Stand directly over item on a flat surface and zoom in for a clear shot.)

Cancelof
Taxpayer's and Dependent(s) Social Security Card(s) (Stand directly over the item on a flat surface and zoom in for a clear shot)

Cancelof
IPPIN IDENTITY THEFT IF (APPLICABLE) (Stand directly over the item on a flat surface and zoom in for a clear shot.)File Upload

Cancelof
Upload W2 statements (Stand directly over the item on a flat surface and zoom in for a clear shot.)

Cancelof
1099 NEC (Stand directly over the item on a flat surface and zoom in for a clear shot.)

Cancelof
Upload other Misc. Income Documents such as 1099 INT, 1099 DIV, 1099NEC. (Stand directly over the item on a flat surface and zoom in for a clearshot.)

Cancelof
Please upload supporting business documents. (ex P&L, 1099 NEC, Summary of Income, Spread sheet with expenses). (Stand directly over item on a flat surface and zoom in for a clear shot.)

Cancelof
Audit Guard Protection

I hereby want to enroll into the Audit Guard Protection Plus. I am aware there is an
one-time annual fee of $59.95 (which will be deducted from my tax refund) to
obtain a Certificate of Membership.

The Membership consists of the following:

● Access to Experienced Tax Professionals - Expert assistance with interpreting
and resolving federal and state audits and inquiries.

● ID Theft Assistance - Comprehensive personalized recovery services for identity
theft incidents.

● Tax Credit and Taxpayer ID Assistance - Help to get denied credits funded an
obtain an Individual Taxpayer Identification number.

● Tax Debt Relief – Help with Identifying and resolving debt owed to the taxing
authorities.
I am giving __________________________, a subsidiary of Purple Label Financial (PLF) and/or associated affliates permission to prepare all forms related to my tax return and I have signed all necessary forms to file my income tax return electronically. I take full responsibility for the accuracy of this client intake form and understand that Purple Label Financial (PLF), and/or associated affliates hold no responsibility for any misrepresentation or false claims. UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THIS TAX RETURN, ACCOMPANYING SCHEDULES AND STATEMENTS, AND TO THE BEST OF MY KNOWLEDGE THEY ARE TRUE AND CORRECT.
Name

First NameLast Name
Signature

Powered by Jotform SignClear
Date

MonthDayYear
Date
Please verify that you are human*
Date of Birth

MonthDayYear
Date
Should be Empty: