Tax Preparation Client Intake Form

DAS Tax Pros Tax Preparation Client Intake Form

PLEASE FILL OUT ALL INFORMATION APPLICABLE AND EMAIL OR SUBMIT TO BEGIN THE TAX FILING PROCESS.Thank You,
Filing Status

Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Are you a full-time student?
Are you totally and permanently disabled?
Are you legally blind?

Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Are they a full-time student?
Are they totally and permanently disabled?
Are they legally blind?
Are they your dependent?

Enter your dependents here

Rows	Name	Date of Birth	Relationship
1
2
3
4
5
6

Does 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
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Please fill-up the information within the current year only.

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

Total Expenses
Additional comments

Date Signed

MonthDayYear
Date
Taxpayer Signature
Date Signed

MonthDayYear
Date
Spouse Signature
I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing DAS Tax Pros to prepare my taxes based on the information I provided. I understand that I am financially responsible for any outstanding balance due to any false information given. If there is a balance due, I must pay the tax preparation fee upfront. If for any reason I owe an entity and they take the entire refund, I am STILL responsible to pay the tax preparation fee for services rendered. If for any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $300 is required. Please view your tax return, which is emailed to you (it is sent prior to submission). Any copy is a fee of $10.00. All FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS TO THIS! Please utilize your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are Federal, and State taxes are State taxes when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions. For any direct assistance please email Dastaxpro@gmail.com or the IRS for all updates at 800-829-1040. Please click this link to check your federal refund status. You will need your filing status, social security number, and the total amount of the refund before fees https://sa.www4.irs.gov/irfof/lang/en/irfofgetstatus.jsp
Should be Empty:

DAS Tax Pros Tax Preparation Client Intake Form