Allen Consulting & Advisory Services Client Intake Form

Allen Consulting & Advisory Services Client Intake Form

Reagan Spears
Personal Information
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Occupation
Date of Birth (MM/DD/YYYY):
Social Security Number (SSN):
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
IRS IP PIN #:
Proof of residency for Head of Household Filers

Ex. Lease agreement, utility bills, mortgage interest statement or, property insurance statement PLEASE NOTE IF YOU CANNOT PROVIDE ONE OF THESE REQUESTED DOCUMENTS, YOU CANNOT CLAIM THIS FILING STATUS PER IRS REGULATIONS. YOUR FILING STATUS WOULD BE CONSIDERED "SINGLE"
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Tax payer's Identification

Please upload a CLEAR pic of a valid Drivers license or State ID.
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Marital Status (Check one):
Spouse's Full Name (if applicable):

First NameMiddle NameLast Name
Spouse's Social Security Number (if applicable):
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Dependents Information
Name of Dependent #1:

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Social Security Number (SSN):
Relationship
Name of Dependent #2:

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Social Security Number (SSN):
Relationship
Name of Dependent #3:

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Social Security Number (SSN):
Relationship
Name of Dependent #4:

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Social Security Number (SSN):
Relationship
Name of Dependent #5:

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Social Security Number (SSN):
Relationship
IF YOU ARE CLAMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NO ONE ELSE IS ELGIBLE TO CLAIM THE DEPENDENT BUT YOURSELF.
If claiming son/daughter, where is the other parent of the dependent/dependents? Is the other parent providing any financial support?
If claiming niece, nephew, aunt, or uncle how are you related to the dependent? Where are the parents to the dependent/dependents?
If claiming brother/sister how are you related to the dependent? Where are the parents to the dependent/dependents?
If low income status, How are you able to provide for dependents?
Did you pay childcare for any of the dependents listed above?
Daycare Tax Statement

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Income Information
2024 W2(s) Upload:

Upload ALL 2024 W2s
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Self-Employment Income (1099 Forms):

Proof of self-employment income forms
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Business Name:
EIN:
XX-XXXXXXX
Total Income:
Business Expenses:
Other Income (Social Security, Rental, Investment, etc.)

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Tax Credits (if applicable):
Child Tax Credit
Education Credits:
Earned Income Credit:
Did you attend a college, university, or accredited trade school in the previous tax year? If yes, please upload your 1098-T form here.

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Health Insurance Information:
Do you have health insurance?
Market Place 1095-A Form

Upload marketplace forms here
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Banking Information:
Bank Name
Account Type
Routing Number
Accounting Number
Prior Year Tax Information:
Have you filed taxes in the previous year?
If yes, please provide a copy of last year's tax return.

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If you would like to file previous years, upload your W-2 forms for the previous years.

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Additional Information:
Do you have any other financial concerns or situations that could affect your tax filing?
File Upload

(e.g., recent inheritance, business deductions, etc.)
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Please provide any other documents that might be helpful in preparing your taxes:

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Dependent Social Security Card

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Dependent Birth Certificate

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Do you owe any delinquent?
Are you applying for the refund advance loan?
Were you referred?
Who referred you?
First & Last name
I, hereby, state that all the information above is true to the best of my knowledge and that I am allowing Allen Consulting & Advisory Services to prepare my taxes based on that fact. I understand that I am financially responsible for any outstanding balance due to any false information given.

If there is a balance due, you must pay the tax preparation fee upfront. If for any reason you owe an entity and they take the entire refund, you are STILL responsible to pay the tax preparation fee for services rendered.

*For any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $150.00 is required! Please view your tax return, which is emailed to you (it is sent prior to submission). Any copy after the first copy is a fee of $10.00.

ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS TO THIS!

Please utilize www.irs.gov for all federal refund tracking. Please utilze your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal, and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions.

For any direct assistance please email admin@allenconsultingandadvisoryservices.com

IRS Contact 800-829-1040

Please click this link to check your federal refund status. You will need your filing status, social security number, and the total amount of the refund before fees

https://sa.www4.irs.gov/irfof/lang/en/irfofgetstatus.jsp
Signature
Date

MonthDayYear
Date
Consent and Agreement

By submitting this application, I understand and consent to providing my personal information including but not limited to my full name, date of birth, social security number, and banking information. I acknowledge that this information is necessary for verification purposes, to grant me access to the software, and to ensure that I receive payment upon the funding of tax returns. I agree to the use of my personal information for these purposes and confirm that all information provided is accurate and up-to-date.
Do you agree to the terms outlined above?
Signature
If you have any questions or comments for your tax preparer, leave them here and we will be in touch within 24 hours.
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Allen Consulting & Advisory Services Client Intake Form

Personal Information

Dependents Information

Income Information

Tax Credits (if applicable):

Health Insurance Information:

Banking Information:

Prior Year Tax Information:

Additional Information: