Ikonic Tax Client Intake Form

Client Intake Form

Please fill out the following form to provide your financial background and dependent details necessary for completing your tax return.
Full Name*

First NameLast NameSuffix
Email Address*
example@example.com
Tax payer's IP PIN (Identity Protection Personal Identification Number)
Applicant Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Residential Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
What is your filing status?*

SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow(er)
What kind of return are you filing?

IndividualJointBusinessAmended (this is the same price as a regular tax return depending on the type)Other
Did you receive a 1095-A form? If yes, please email a copy for tax purposes.

YesNo
Did you get audited last year?

YesNo
Dependent Information
Dependent 1 Full Name

First NameLast NameSuffix
Dependent 1 Date of Birth

MonthDayYear
Date
Dependent 1 Age
Dependent 1 Relationship to You
Dependent 1 IP PIN (Identity Protection Personal Identification Number)
Dependent 2 Full Name

First NameLast NameSuffix
Dependent 2 Date of Birth

MonthDayYear
Date
Dependent 2 Age
Dependent 2 Relationship to You
Dependent 2 IP PIN (Identity Protection Personal Identification Number)
Dependent 3 Full Name

First NameLast NameSuffix
Dependent 3 Date of Birth

MonthDayYear
Date
Dependent 3 Age
Dependent 3 Relationship to You
Dependent 3 IP PIN (Identity Protection Personal Identification Number)
Are any of your dependents adopted?

YesNo
Dependent Caregiver Name for dependents ages up to 13
Caregiver Phone Number
Please enter a valid phone number.
Caregiver Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Dependent Care Expenses ($)
Banking Information

Direct deposit your tax return. Some banks qualify for 5 day advance deposits.
Bank Name
Account Number
Routing Number
Client Consent Signature*

Clear
Should be Empty:

Client Intake Form

Dependent Information

Banking Information