Client Intake form

Tax Client Information Form

Get the Maximum Refund Amount
Tax Preparers Name *
Your Name*

First NameLast Name
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*
SSN*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Occupation
Are you a Full Time Student?*

YESNO
Do you receive SSI?*

YESNO
Do you owe the IRS ?*

YESNO
Do You owe Child Support?*

YESNO
Filing Status*
Do you have dependents?*

YESNO
Dependent #1 Name (or Spouse Information)

First NameLast Name
Dependent #1 Date of Birth ( or Spouse Information)
Dependent #1 SSN ( or Spouse Information)
Dependent #2 Name

First NameLast Name
Dependent #2 Date of Birth
Dependent #2 SSN
Dependent #3 Name
Dependent #3 Date of Birth
Dependent #3 SSN
Do you own a business? If so please provide EIN and business name *
Did you, your spouse or your dependents have Health Insurance with Marketplace?*
Do you have a 6 digit Pin provided by the IRS? If so please provide ( copy and paste link below in your browser to retrieve your pin ) *
https://www.irs.gov/identity-theft-fraud-scams/get-an-identity-protection-pin
https://www.irs.gov/identity-theft-fraud-scams/get-an-identity-protection-pin
Self Employment Income Amount

Self Employment Write Off Sheet

Upload Driver License, Birth Certificate Req. for all Dependents, SSN card, W2, 1099 ,1095 A (if applicable) , and any form that needs to be Filed with the IRS

Cancelof
How do you want to receive your refund?

via checkvia direct depositA Debit card can be provided to you by your Tax Preparer
For Direct Deposit : Bank Name
Routing Number
Account Number
* By clicking submit you agree for TAX CHECKS ATL LLC to file your Tax Return with the IRS.

( Please note a Tax Quote will be emailed to you before your tax return is filed with the IRS, Please respond to that email.)
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Tax Client Information Form