Tax Client Intake Form
Referred By?
*
Filing Status
*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
SSN:
*
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
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.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
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
Dependent #1
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
SSN
Relationship
Please Select
Son
Daughter
Stepchild
Grandparent
Uncle
Aunt
Niece
Nephew
Brother
Sister
Mother
Father
Dependent #2
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
SSN
Relationship
Please Select
Son
Daughter
Stepchild
Grandparent
Uncle
Aunt
Niece
Nephew
Dependent #3
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
SSN
Relationship
Please Select
Son
Daughter
Stepchild
Grandparent
Uncle
Aunt
Niece
Nephew
Dependent #4
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
SSN
Relationship
Please Select
Son
Daughter
Stepchild
Grandparent
Uncle
Aunt
Niece
Nephew
Tax Related Questions
Employment Status
*
Employed
Unemployed
Self-employed
Did you pay anyone to watch your children?
Yes
No
Did you collect social security or retirement income?
Yes
No
Did you purchase health insurance through healthcare.gov marketplace? Obama Care
Yes
No
If yes, did you receive a 1095-A Form from the marketplace?
Yes
No
Were you ever disallowed the E.I.T.C prior to this year?
Yes
No
Did you take money from your 401k?
Yes
No
Did you make a college tuition payment and received a 1098-T Form?
Yes
No
Do you have any other income other your W2?
Yes
No
Did you file 2023 taxes?
Yes
No
Did you successfully receive your federal taxes last year?
Yes
No
Are you delinquent in any of the following?
Child Support
Alimony
Student Loans
Back Taxes
State Taxes
None of the above
Direct Deposit Info
Bank Name
Routing Number
Account Number
Upload Important Documents
Photo Identification
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Taxpayer Social Security Card
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Dependent Social Security Card
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Dependent Social Security Card
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Dependent Social Security Card
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Dependent Social Security Card
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W2(s)
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1099(s)
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Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow THOMFLIP FINANCIAL 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 ABC Financial.
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
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