Tax Preparation Client Intake Form
Please complete the form to the best of your knowledge. Click on the sideways triangle to expand the sections. NEW CLIENTS- Are eligible for a 4 days 3 night Vacation Package to the destination of their choosing, upon the successful filing and payment in full for tax services.
Taxpayer Information
Name
*
First Name
Last Name
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
Are you Filing Jointly with your Spouse?
*
Yes or No?
Spouse Information if Filing Jointly
Name
First Name
Last Name
Marriage Year
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
Are they totally and permanently disabled?
Yes
No
Do you have any dependents?
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
Tax Related Questions
Employment Status
Employed
Unemployed
Self-employed
Does your dependents have tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
Do you receive rent?
Yes
No
How long have you lived at the property?
# of months
Do you own additional property?
Yes
No
Do you have documents that shows you paid for property taxes?
Yes
No
Did you sell any stock?
Yes
No
Did your receive a 1099 K?
Yes
No
Did you take money from your 401K?
Yes
No
Did the IRS provide you with a PIN to file your taxes?
Yes
No
Do you have a business?
Yes
No
Business Expenses
Please fill-up the information within the current tax year only.
Business Expenses
Rows
Amount
Advertising
Gas
Insurance Premiums paid (other than health)
Entertainment
Office Supplies
Legal and Professional Services
Repairs and Maintenance
Taxes and Licenses
Office Space
Vehicle Costs
Tax Preparation Fees
Investment Expenses
Other
Total Expenses
Additional comments
Do you have another business ?
Yes
No
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
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
Print
Submit
Submit
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