Client Intake Form

Client Intake Form

Britton Concepts Inc Tax in partnership with J.Well & Company Tax Preparation Services.
How did you hear about us?
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
Birthdate

MonthDayYear
Date
SSN
Occupation Title
Spouse Full Name

First NameLast Name
Spouse Email
example@example.com
Spouse Phone Number
Please enter a valid phone number.
Spouse Occupation
Dependent 1 Name, Dependent 1 Social Security #, Dependent 1 Date of Birth, Dependent 1 Relationship
Dependent 2 Name, Dependent 2 Social Security #, Dependent 2 Date of Birth, Dependent 2 Relationship
Dependent 3 Name, Dependent 3 Social Security #, Dependent 3 Date of Birth, Dependent 3 Relationship
Dependent 4 Name, Dependent 4 Social Security #, Dependent 4 Date of Birth, Dependent 4 Relationship
If any of your dependents are disabled list them here
Are you disabled?

YesNo
Select your filing status

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointWidowed
Were you audited by the IRS last year?

YesNo
Did you receive marketplace health insurance?

YesNo
Do you have an IP PIN?

YesNo
Do you have any credits that were disallowed or reduced?

YesNo
If you have any cre-dits that were disallowed or reduced, please enter here.
2024 Identity Protection Pin & who it was issued to. (If applicable)
Please upload proof of residency for each dependency.

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If you are filing head of Houshold, what documents will you provide for proof of head of household?

Utility BillRental LeaseRent ReceiptMortgage Interest PaymentsProperty Tax PaymentsOther
Please upload proof of head of household, if applicable.

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Please upload your dri-ve-ing li-cense/ID for you & your spouse (if applicable)*

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SSN for Each Individual on Return*

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Please answers only if it applies to you.
If your address is different than the one thats on your go-vernment ID or dri-vers license, please indicate the reason why
If applicable, please indicate why you are claiming a dependent that is not related to you. What are the circumstances that you have supported this dependent for at least 6 months of 2024. Please outline the support you have provided to this dependent.
Are all of the dependents being claimed related to the taxpayer by birth or bloodline? If not, please identify which child is not related to you?
Please answer if applicable, if your last name is different than your dependent's last names, that you are filing, what is the reason why? Please indicate the reason why there is a difference in the last names between you and your dependents.
Please answer, only if applicable: If your income is at or below $13,000.00 & you have 2 or more children, how are you able to maintain the household. For example, did you receive government assistance, as such as: section 8, public housing, SNAP benefits, or other.
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?

YesNo
Did you have a business in 2024? Includes 1099s, or side business. Ex. hair braiding, hair stylist, baby sitting, uber, lyft, door dashing, & etc. If so, what is the name & nature of your business or side business. If you don't have a name, you can bypass the name.
Did you purchase a vehicle recently?

YesNo
If yes, please list the year make and model of the vehicle.
Other Documents

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Do you want to apply for cash advance up to $7k. No credit check. You will be notified if you are approved within 24 hours.

YesNo
How do you want to receive your refund?

Printed CheckDirect DepositGo 2 Bank Prepaid debit card
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 Britton Concepts Inc Tax. 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 - Britton Concepts Inc Tax.
Tax Payer Signature ( Must be legible)*

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Spouse Signature

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Notes (anything you think we need to know)
Should be Empty:

Client Intake Form

Please answers only if it applies to you.

Federal Financial Documents

If you selected direct deposit, please enter your information below