Clone of Tax Prep Intake

Hometown Tax Service

Client Intake Form
Thank you for taking the time to complete the Client Intake Form.

This information is critical to ensure your tax return is filed accurately!

Please take your time and review all information before you submit. Please note that if any documents are missing or information is incorrect this will result in a delay in processing your return.

This intake form will take 20- 30 minutes to complete.

Please complete this form in its ENTIRETY and click SUBMIT when finished. Upload all documents where instructed to do so. If you uploaded documents to our mobile app, you will still need to upload again.

It is imperative that you wait until you have all supporting documents before completing and submitting this form!!

If you are claiming any dependents, be sure to upload their SS CARDS, BIRTH CERTIFICATES, and all items that show their address is the same as yours. (e.g. school records, medical records, doctor bills, Medicaid Statement, Social Services Records, or anything that shows your child's name and current address).

PLEASE READ THIS CAREFULLY BEFORE SUBMITTING. DO NOT SUBMIT THE FORM UNTIL YOU HAVE ALL REQUIRED SUPPORTING DOCUMENTS. FAILURE TO FOLLOW THESE INSTRUCTIONS WILL RESULT IN YOUR INTAKE FORM NOT BEING PROCESSED. ENSURE ALL SUPPORTING DOCUMENTS ARE VALID AND UP-TO-DATE. IF APPLICABLE, LEASE AND OTHER FORMS MUST INCLUDE THE DEPENDENT'S NAME.
How did you hear about us?
What tax year is this submission for? If you need more than one year filed, it should be submitted as a separate submission for each year.*

2025 (current year)2024202320222021
Choose a preparer

Tiffany GravesJoycelyn FittsJasmine BrooksFelisha Grant
Will this be an amended (corrected) return?

YesNo
Will you be interested in applying for an advance loan?*

YesNo

Spouse Information
Upload a valid DL or ID. Lay on a flat surface and zoom in to get a clear photo,

Cancelof
Upload a selfie to Validate DL or ID.

Cancelof
Name

First NameLast Name
Occupation
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Are they a full-time student?

YesNo
Are they totally and permanently disabled?

YesNo
Are they legally blind?

YesNo
Are they your dependent?

YesNo

Dependents
Do you have dependents?

YesNo
Did all of the dependents listed, live in the home with you?

YesNo
Dependent 1
First Name
Last Name
SSN
Date of Birth

MonthDayYear
DOB
Is The dependent a citizen of the USA?
Was this dependent a full time student?
Relationship
Number of months the person have lived in your home in 2024
Dependent 1 Supporting Documentation

Example: Birth Certificate, Shot Record, School Record, Lease Showing Child As Resident
Cancelof
Dependent 2
First Name
Last Name
SSN
Date of Birth

MonthDayYear
DOB
Is The dependent a citizen of the USA?
Was this dependent a full time student?
Relationship
Number of months the person have lived in your home in 2024
Dependent 2 Supporting Documentation

Example: Birth Certificate, Shot Record, School Record, Lease Showing Child As Resident
Cancelof
Dependent 3
First Name
Last Name
SSN
Date of Birth

MonthDayYear
DOB
Is The dependent a citizen of the USA?
Was this dependent a full time student?
Relationship
Number of months the person have lived in your home in 2024
Dependent 3 Supporting Documentation

Example: Birth Certificate, Shot Record, School Record, Lease Showing Child As Resident
Cancelof
IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NOBODY ELSE IS ELIGIBLE TO CLAIM YOUR 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 a sister, brother, niece, nephew, aunt, or uncle, why are the parents not claiming the dependent/dependents?
Did you pay any child care expenses for any dependents listed above?

Refund Disbursement
Are you interested in the SAME DAY Advance up to $1,000 with no interest?

YesNo
Are you interested in the SAME DAY Advance up to $7,000 with interest?

YesNo
Refund Disbursement Method
If you selected direct deposit, please provide your account details below. Please be sure you are the account Holder
Bank Name
Financial Institute
Is this a checking or a savings?

CheckingSavings
Account Number
Verify Account Number
Routing Number
Verify Routing Number
Do you have any other income than your W-2(s)?

YesNo
Please Upload Your Tax Document(s)(W2, 1099, 1098-T, Etc)

Cancelof
Tax Payer Social Security Card

Cancelof
Dependent Social Security Card(s)

Cancelof
Anything you'd like us to know when preparing your return?

Acknowledgment & Signature
STOP

Did you finishing uploading all of your supporting documents?

IF YOU DID NOT UPLOAD ALL NECCESSARY DOCUMENTS YOUR INTAKE FORM WILL BE DEEMED NULL AND VOID.
CLIENT NON-PAYMENT / OFFSET CLAUSE

At Hometown Tax Service LLC, we strive to assist all of our clients in their tax needs, however, we understand that situations arise. If your refund is offset by the IRS, student loans, child supoort or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return.

By signing this agreement you acknowledge that if payment is not made in full within 30 days legal actions will be sought to resolve payment.
Taxpayer's Primary signature*

Clear
I acknowledge that all information provided to Hometown Tax Service is true and accurate to the best of my knowledge.

I understand that I am required to have any supporting documentation to validate the information provided.

Furthermore, I understand that knowingly providing false information on my tax return and reporting it to the IRS, that I am taking part in a potentially criminal penalty situation and is punishable by law including but not limited to; facing court dates, restitution and possible imprisonment.

I waive Hometown Tax Services and the preparer of any error due to incorrect information provided by me. By signing below, I authorize Hometown Tax Service to prepare all forms related to my tax return. To apply for a secure RAC's and RAL's on my behalf, sign all neccessary forms and file my taxes electronically. I take full responsibilty for the accuracy of this form and the information I have provided.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

Clear
Date Signed

MonthDayYear
Date
Spouse Signature

Clear
Should be Empty:

Hometown Tax Service

Dependent 1

Dependent 2

Dependent 3