NEW CLIENT INTAKE FORM GRAHAMITH

Tax Filing Year *
Select Your Tax Preparer*
Please provide the name of the person who referred you or provide the place where you saw our business.
Filing Status*

Head of HouseholdSingleMarried Filing JointlyMarried Filing SeparateQualifying Widow With Dependent
Do You or Your Children Have an IP PIN?*

YesNo
IP PIN (issued from IRS yearly) EVERYONE DOESNT HAVE THIS. IF IT DOESNT APPLY SKIP
Did you file last year?*

YesNo
Are you interested in credit repair?

YesNo
Your Full Name*

PrefixFirst NameLast Name
Tax Payers Social Security Number*
Your Phone Number*

Area CodePhone Number
Your E-mail*
example@example.com
Tax Payers Date of Birth*

YearMonthDay
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Did you receive health insurance through the Market Place?*

YesNo
Your Occupation*
Nurse, Rapper, Uber driver
Have you ever been audited by the IRS?
If so, Please provide the year/s of audit and what were the outcomes of the audits
Primary Taxpayer - Please Check Any That Apply

Taxpayer can be claimed as a dependent on someone else's return.Taxpayer was over age 18 and a full-time student at an eligible educational institution.Taxpayer is blind.Taxpayer is deceased.Taxpayer has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.Taxpayer prefers to receive written communications from the IRS in a language other than English.Taxpayer prefers to receive written communications from the IRS in an accessible format.Taxpayer is disabled.
Spouse Information

If no spouse, please skip.
Spouse's Name

First NameLast Name
Spouse's Date of Birth

YearMonthDay
Date
Spouse's Social Security Number
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

Spouse can be claimed as a dependent on someone else's return.Spouse was over age 18 and a full-time student at an eligible educational institution.Spouse is blind.Spouse is deceased.Spouse has received, sold, sent, exchanged, or otherwise acquired financial interest in virtual currency during the current tax year.Spouse prefers to receive written communications from the IRS in a language other than English.Spouse prefers to receive written communications from the IRS in an accessible format.Spouse is disabled.
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

	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

Business Information

Please complete if you are self employed.
Are you self employed or a business owner?*

YesNo
If so what kind of business do you have?
Please provide your business EIN Number
How long have you been in business?
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?

YesNo
If so, list the year make and model of the vehicle.
College Student Information

Please complete if anyone in your household went to college.
Did Anyone Listed On This Return Attend College this Tax Season?*

YesNo
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?
Was the student ever charged with drug related felonies?

YesNo
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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Please upload a copy of utility bill*

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

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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:

Up to $7000 (with finance charge)
Signature Consenting to Form 7216 Bank Consent to Disclosure of Tax Return Information*

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How would you like your refund to be deposited when ready?*

Direct DepositPre-Paid Debit CardI have a Tax Obligation and will not be receiving a refundPaper check printed in the office
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?*

YesNo
If you are a single parent, Where's the other parents 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?*

YesNoNot NeededNot Applicable
Is anyone else eligible to claim this dependent on their tax return?*
Did you pay someone to watch your child/children?

YesNoNot Applicable
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?*

YesNo
In the case of a random IRS audit, can you provide all documentation reported?*

YES
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*

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Spouse Information

Dependent Information

Business Information

College Student Information

Upload Requested Documents

Banking Information

Due Diligence Questions

Signature