Prospective Client Intake Form

1

Name* This field is required.

First Name

Last Name

2

Email Address* This field is required.

example@example.com

3

Phone Number* This field is required.

5

Who referred you?

6

How do we know each other?

7

Please describe how you heard about us

8

Which services are you interested in?* This field is required.Select all that apply

Individual Taxes

Business Taxes

Tax Consulting

Tax Resolution (IRS and State Notices)

9

Resident State* This field is required.Select the state you live in

10

Do you need to file a return in another state in addition to your resident state?* This field is required.This could be due to a move or business activity in multiple states

YESNO

11

What other state(s)?Select all that apply

12

What is your filing status?* This field is required.

Single

Married Filing Jointly

Married Filing Separately

Head of Household

Qualifying Surviving Spouse

Unsure

13

Your Spouse's Name* This field is required.

First Name

Last Name

14

Your Spouse's Email Address* This field is required.

example@example.com

15

What is your estimated income for the year?* This field is required.

$0 - $49,999

$50,000 - $99,999

$100,000 - $149,000

$150,000 - $249,999

$250,000 - $499,999

$500,000 - $999,999

$1,000,000+

16

How many W-2s do you have for the year?* This field is required.

17

Did you receive company stock incentives through your employer?Select all that apply

Received Restricted Stock Units (RSUs)

Received or exercised stock options

Participated in an Employee Stock Purchase Plan (ESPP)

Unsure

18

How many 1099-R or SSA-1099 form do you receive for the year?* This field is required.Typically received for distributions from a retirement account or social benefits

19

Do you have dependents (children or other dependents) that you will claim on your tax return?* This field is required.

YESNO

20

Do you have dependent care expenses (daycare, pre-school, etc.)?

YESNO

21

Did you pay post-secondary (college) expenses for yourself or a dependent (including a spouse)?* This field is required.

YESNO

22

Do you own rental property (that you own and rent to others)?* This field is required.This also includes if you rent out your primary home on Airbnb, VRBO, etc. or rent a room to a roommate.

YESNO

23

How many rental properties do you have?

24

What type of rental property do you have?Select all that apply

Long-term rental

Vacation rental

I rent a portion of my primary residence to a roommate

I rent my primary residence (or a portion of it) on Airbnb, VRBO, etc.

25

Did you or will you sell a rental property during the year?

YESNO

26

How do you keep your financial records for the rental properties?

Accounting software (QuickBooks, Xero, etc.)

I use a management company

Spreadsheet

Other

27

Do you itemize your deductions or take the standard deduction?* This field is required.Itemized deductions generally include medical expenses, state and local taxes, mortgage interest, and charitable contributions.

Itemize

Standard Deduction

Unsure

28

Do you have investment income?* This field is required.This includes capital gains and losses from the sale of stock or other investments, dividends received, and interest income earned.

YESNO

29

What kind of capital gains or losses?Select all that apply

Brokerage statement

Sold stock

Sold investment property

Sold primary residence

Crypto (Bitcoin, Etherium, etc.)

Other

30

Did you buy, sell, receive or otherwise have any activity related to crypto/digital currencies?* This field is required.

YESNO

31

How many crypto/digital currency transactions (buying, selling, staking, etc.) do you estimate you had in the year?

1 - 15

16 - 50

51 - 100

100+

32

Did you use a third-party software to track your crypto activity?CoinLedger, CoinTracker, Koinly, etc.

YESNO

33

Did you purchase your health insurance through healthcare.gov or a state marketplace?* This field is required.

YESNO

34

Do you have a health savings account (HSA)?* This field is required.

YESNO

35

Are you self-employed?* This field is required.This can include a side hustle, sole proprietorship, or 1099 income.

YESNO

36

Please describe your self-employment activity.* This field is required.If there is more than one activity, please describe each here.

37

Are you a partner or shareholder in any business or a trust beneficiary?* This field is required.You receive a K-1 from the entity.

YESNO

38

How many K-1s do you receive?* This field is required.

39

What is the name of your business?* This field is required.

40

What state does your business operate in?* This field is required.Where are you / your business physically located?

41

Do you need to file a business return in any other state in addition to your primary state?* This field is required.

YESNO

42

What other state(s) does your business need to file a return in?

43

How is your business structured for tax purposes?* This field is required.

S Corporation (can be an LLC)

C Corporation

Partnership

Sole Proprietorship

Nonprofit Organization

Unsure

45

Please describe your industry.

47

What is the business's estimated gross revenue for the year?

0 - $100,000

$100,001 - $250,000

$251,000 - $500,000

$500,001 - $1,000,000

$1,000,001 - $5,000,000

$5,000,000+

48

Does your business have employees?

YESNO

49

How many employees?Include yourself if you receive a W-2 from the business.

50

Including yourself, how many business owners are there?

51

Does your business have and track inventory?

YESNO

52

Is your business required to collect sales tax from customers?

YESNO

53

Which statement best describes you currently?* This field is required.

I just want someone to prepare my tax return for me.

I want an advisor I can trust when I have tax questions.

I want to reduce taxes, plan for the future, and avoid surprises at tax time.

I need help with payroll.

I need help with bookkeeping.

Unsure

54

Please upload your prior year tax returnThis is not required, but it is helpful to determine if we are good fit.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

55

Did you receive a notice from the IRS?

YESNO

56

Did you receive a notice from a state agency?

YESNO

57

What state did you receive a notice from?

58

Please describe your understanding of the notice you received

59

We do not currently support notice resolution for states outside of California and the IRS. Thank you for considering Quinton Boucher, CPA for your notice resolution needs.

60

Please upload your noticeThis is not required, but it is helpful to determine if we are good fit to help resolve this issue.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

61

Please describe the tax consulting service you're looking for* This field is required.