Haven Tax Solutions Client Intake Form

Haven Tax Solutions Client Intake Form
" Thank you for completing your Client Intake Form. Please review all information carefully before submitting. Missing or incorrect information may delay the processing of your tax return."
Choose Tax Preparer:

Marquidda NixonCrystal Crochet
Client Status:

Enter your dependents here ( Select Y or N if they are disabled )

Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?*

If your insurance was through the Affordable Care Act (The Marketplace) please upload your 1095-A Form?

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All W2 Forms

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Additional Documents

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General Expenses( Optional)

Acknowledgment & Signature
- I confirmed that all information I entered here is accurate and true.
- I allow Haven Tax Solutions LLC to capture my sensitive data like personal id, government id, and other information.
- I have read the terms and conditions and privacy policy of Haven Tax Solutions LLC.
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
"STOP! Make sure all required documents are upload. Incomplete intake forms will be voided. If your refund is offset (IRS, student loans, child support) or mailed, your are still responsible for all tax preparation fees. By signing, you agree that unpaid balances after 30 days may result in legal action."
" If you are receiving a refund, what method would you like it disbursed?*

Direct DepositCheckBy MailOther
Bank Account Type:*

Checking AccountSavings Account
Bank Name*
Route Number:*
Bank Account Number*
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

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Date Signed

MonthDayYear
Date
Spouse Signature

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BEFORE YOU SUBMIT GO BACK AND REVIEW!!

"Ensure all documents are current and valid. Returns with missing or invalid documents will be placed on hold and will not be e-filed until corrected"
Thank you for choosing Haven Tax Solutions.We apprecite your business and are grateful for the opportunity to serve you.
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