Euqinrahc Financials Intake Form
How were you referred?
What year are you filing?
Please Select
2025
2024
2023
2022
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
If filing Head of Household, you must present one of the following to use this filing status. Select the one that you will upload to be approved for HOH filing status.
Lease
Utility Bill
Mortgage Statement
Taxpayer Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Do you have a Identity Protection Pin
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Are you legally blind?
Yes
No
Spouse Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Do you have a Identity Protection Pin
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they legally blind?
Yes
No
Are they your dependent?
Yes
No
Dependents
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
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Health Care Insurance Form
Tax Related Questions
Employment Status
Employed
Unemployed
Self-employed
Are you contributing to 401k or other pre-tax account?
Yes
No
Is this your first time opening a pre-tax account?
Yes
No
Does your dependents have tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
Do you have energy star rated improvements to your home?
Windows
Doors
Furnace
Other
Are you currently renting?
Yes
No
What is the monthly rental amount?
How long have you lived at the property?
# of months
Do you have your own home?
Yes
No
Do you have documents that shows you paid for property taxes?
Yes
No
Did you sell any stock?
Yes
No
Did you take money from your 401?
Yes
No
Did you pay your vehicle tax?
Yes
No
Do you have mortgage interest?
Yes
No
Do you have real estate tax?
Yes
No
Did you receive a federal tax last year?
Yes
No
Are you a victim of identity theft?
Yes
No
Expenses
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
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow Euqinrahc Financials to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of Euqinrahc Financials.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed
-
Month
-
Day
Year
Date
Taxpayer Signature
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
Take Selfie w/ ID.
Identification Card
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Income ( W2, 1099, Self Employed)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Social Security Card
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Child Birth Certificate & Social Security
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Bill if filing Head Of Household
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Any other documents
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Who are you looking to file with?
B.Ervin
Charderial Terrell
Sedarany Chea
Chetori Green
Kalyn Leroy
Destyni Lee
Juanita Brown
Malieka Rooney
Charnique Williams
Devony Boutte
DeAshley Hamilton
Niquera Williams
Print
Submit
Submit
Should be Empty: