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.
Who is your tax professional?
IF LEFT BLANK THE OWNER WILL PROCESS YOUR RETURN.
Full Name*

First NameLast NameSuffix
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Do you give permission for us to send you text messages and emails regarding updates, promotions, and marketing? You can opt out at any time.*

YesNo
Spouse Full Name

First NameLast NameSuffix
Tax payer's IP PIN (Identity Protection Personal Identification Number)
Applicant Date of Birth*

MonthDayYear
Date
Social Security Number (SSN)*
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
Social Security Number (SSN)
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
Social Security Number (SSN) for Dependent 2
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
Social Security Number (SSN) for Dependent 3
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. If you do opt into paper check, there is a fee up to $25.00-$50.00.
Bank Name
Account Number
Routing Number
Would you like the advance up to $7,000? Your advance would be deposited the same way your tax refund is deposited.*

YesNo
Please note there is an advance application fee of $100 added to your fee.
BY YOU SIGNING THIS DOCUMENT YOU GIVE I'KONIC TAX RELIEFE PERMISSION TO FILE YOUR RETURN AND ALL DOCUMENTS PROVIDED IS CORRECT. YOU ALSO UNDERSTAND YOU NEED TO UPLOAD ALL DOCUMENTS NEEDED TO COMPLETE YOUR RETURN IF NOT THIS WILL DELEY YOUR PROCESS. WE DO OFFER PICK UP AND DROP OFF SERVICE FOR AN ADDTIONAL FEE, PLEASE SPEAK TO YOUR TAX PROFESSIONAL.

**“Please note: If a tax return amendment becomes necessary due to missing, incorrect, or withheld information on your part, an upfront amendment fee will be required.”
Client Consent Signature*

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Client Intake Form

Dependent Information

Banking Information