Client Intake Form

Client Intake Form

Thank you for choosing Liberated Services for your tax preparation needs. Please complete the following form to provide us with the information necessary to accurately prepare and file your tax return. All details submitted will be kept confidential and used solely for tax preparation purposes.
Tax Information
Tax Year
SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow(er)
Taxpayer Information

IRS PIN # (for internal use only):
Taxpayer Full Name

First NameLast Name
Taxpayer Email Address
example@example.com
Taxpayer Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Taxpayer Social Security Number
PhoneTextEmail
Taxpayer Occupation
Spouse Information (If Applicable)

IRS PIN # (for internal use only):
Spouse Full Name

First NameLast Name
Spouse Email Address
example@example.com
Spouse Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
PhoneTextEmail
Spouse Social Security Number
Spouse Occupation
Taxpayer Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Dependents (INCLUDING NON-CHILD DEPENDENTS)
E-File/Filing Info -Refund/ PMT Info

Please provide the following E-Filing information to receive your tax refund.
Paper Check (Mail)Direct Deposit
Bank Name
Routing Number
Account Number
Date

MonthDayYear
Date
Signature

Clear
Payment (For Office Use Only)
Should be Empty:

Tax Information