CLIENT INTAKE FORM GRAHAMITH

Select Your Tax Preparer
Select or Enter who referred you
Please provide the name if not listed
Filing Status
If you’re filing married separately, how many months out of the year were your living apart from your spouse?
If you are filing head of household, are you unmarried?
Did you file last year?
Do You or Your Children Have an IP PIN?
IP PIN (issued from IRS yearly) EVERYONE DOESNT HAVE THIS. IF IT DOESNT APPLY SKIP
Your Full Name

PrefixFirst NameLast Name
Your Phone Number

Area CodePhone Number
Your E-mail
example@example.com
TaxPayer Date of Birth

MonthDayYear
Date
Taxpayer Social Security Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Occupation
Nurse, Rapper, Uber driver
Did you receive health insurance through the Market Place?
Have you received a 1095-A?
Yes or No
Spouse Information

If no spouse, please skip.
Primary Taxpayer - Please Check Any That Apply
Spouse's Name

First NameLast Name
Spouse's Social Security Number
Spouse's Date of Birth

YearMonthDay
Date
Spouse's Occupation
Spouse's Email Address
example@example.com
SPOUSE IP PIN (issued from IRS yearly) EVERYONE DOESNT HAVE THIS. IF IT DOESNT APPLY SKIP
Spouse - Please Check Any That Apply
Dependent Information

The Earned Income Credit (EIC) increases with the first 3 Children you claim. The maximum number of dependents you can claim for Earned Income Purposes is Three. You MUST also meet other requirements related to your Adjusted Gross Income (AGI) to qualify for EIC. If you are MARRIED and FILING SEPARATE you CAN'T claim the credit.

Dependent Information

Rows	Name	Date of Birth	Social Security Number	Full Time Student? Yes or No	Disabled? Yes or No?	How Many Months Did The Child Live In Your Home?	Relationship To The Dependent
1st Dependent
2nd Dependent
3rd Dependent
4th Dependent

Does your child/children have the same last name as you?
Business Information

Please complete if you are self employed.
Are you self employed or a business owner?
If so what kind of business do you have?
Business Name ?
Please provide your business EIN Number
Are you interested in business credit?
Business Adress

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please upload your profit/expense records.

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Did you have a vehicle you used for your business?
If so, list the year make and model of the vehicle.
Do you have a separate personal vehicle not for work?
College Student Information

Please complete if anyone in your household went to college.
Did Anyone Listed On This Return Attend College this Tax Season?
Was the student ever charged with drug related felonies?
If so - please upload form 1098-T and other college related documents below.

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Name(s) of the person who attended college
How many tax years have you claimed the American Opportunity Tax Credit?
If so please upload your Form 1098-T - Student loan Interest

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Upload Requested Documents

PLEASE NOTE: YOU CAN UPLOAD MULTIPLE DOCUMENTS
Upload ID/DL (for anyone over 18 years old on this filing)

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Upload Social Security Card (for all listed on this filing)

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Please upload a copy of utility bill

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Please upload all W2's HERE - You can upload multiple files

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If you received Unemployment Please Provide 1099-G form

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Withdrawal out of 401K? Please attach documentation if available.

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Please provide Mortgage / Property Tax form(s) if paid taxes / insurance

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Please Upload any Additional Tax Forms that you have Received.

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Please upload Birth Certificates for all dependents.

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Upload copy of prior year tax return or transcript (include the schedule c if was self employed)

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Banking Information
Loan advance:
Signature Consenting to Form 7216 Bank Consent to Disclosure of Tax Return Information
How would you like your refund to be deposited when ready?
Bank Name
Is this a Checking or Savings account?
Routing Number
Confirm Routing Number
Account Number
Confirm Account Number
Due Diligence Questions
Have you ever been disallowed the Earned Income tax Credit, The additional child Tax credit, or the Child tax credit?
If you are a single parent, Where's the other parent of your child/children?
Why is the other parent not claiming the child?
If you are divorced or separated, when did you last live in the same home?
Do you have joint custody of your child? (If so which child/children)
Do you have a signed form 8332 granting the right to claim this child/children?
Is anyone else eligible to claim this dependent on their tax return?
Did you pay someone to watch your child/children?
If so please upload any childcare statements.

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Did you receive any type of supplemental, non taxable income such as child support, Welfare benefits, Social security, etc?
Have you ever been audited by the IRS?
If yes, What year?
In the case of a random IRS audit, can you provide all documentation reported?
Are you interested in credit repair?
Signature

Please Review & Sign Consent Forms
Acknowledgment and Consent

I confirm that all the information I have provided here is accurate and true to the best of my knowledge.
I authorize Grahamith Global Solutions to securely capture and use my sensitive information, including but not limited to personal identification, government-issued ID, Social Security Number (SSN), and other required details for the purposes of this service.
By typing my name and signing below, I acknowledge that I have read, understood, and agreed to the outlined responsibilities of both myself and Grahamith Global Solutions in completing this process.
Your trust and security are our priority.
Signature Consenting to Consent To File Tax
Acknowledgment and Consent

I confirm that all the information I have provided here is accurate and true to the best of my knowledge.
I authorize Grahamith Global Solutions to securely capture and use my sensitive information, including but not limited to personal identification, government-issued ID, Social Security Number (SSN), and other required details for the purposes of this service.
By typing my name and signing below, I acknowledge that I have read, understood, and agreed to the outlined responsibilities of both myself and Grahamith Global Solutions in completing this process.
Your trust and security are our priority.
Should be Empty:

Spouse Information

Dependent Information

Business Information

College Student Information

Upload Requested Documents

Banking Information

Due Diligence Questions

Signature