Intake Form
Name
First Name
Middle Name
Last Name
Suffix
Date Of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Occupation (If none, type Unemployed)
Filing Status
Single
Head Of Household
Married Filing Jointly
Married Filing Seperately
Widowed
Spouse Name
First Name
Middle Name
Last Name
Suffix
Souse Date Of Birth
-
Month
-
Day
Year
Date
Drivers License/Identification Card
Drivers License/ID Number
State Issued In
Issued Date
-
Month
-
Day
Year
Date
Expiration Date
-
Month
-
Day
Year
Date
Which Of The Following Forms Do You Have ( Mark All That Apply)
W2
1099 NEC
1099-G
SSA - 1099
1099 - MISC
1099 - INT
W-2G
1099 - R
Did You Have Marketplace Health Insurance or Receive a 1095-A?
Yes
No
How Many Dependents Are You Claiming
1
2
3
4+
Are You Self-Employed Or A Contract Worker? (Uber, Lyft, DoorDash etc.)
No
Yes, I Have Income & Expenses
Yes But I Only Have Income, No Expenses
Yes But I Only Have Expenses, No Income
Submit
Should be Empty: