Elevated Tax Pros Client Intake Form

Elevated Tax Pros Client Intake Form

Name

First NameLast Name
Social Security Number
This information is required by the IRS to prepare and file your tax return. All personal data is protected and handled securely.
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
YesNo
YesNo
YesNo
YesNo

Enter your dependents here

Rows	Name	Date of Birth	Relationship	Social security numbers
1
2
3
4
5
6

Does you, your spouse, and your dependents have health insurance/ Marketplace insurance within 12 months last year? If yes, who covers for it? Please upload the 1095-A form below.*

Rows	Yes/No	Employer	Spouse Ins	Exchange/ Marketplace	Direct with Insurer	Medicare	Medicaid
Taxpayer
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Please fill-up the information within the current year only.
Business Name
Service Provided
EIN Number
What year was the business established?
Income
Additional comments
Banking Details
Bank Name *
Account Number*
Routing Number*

- I confirmed that all information I entered here is accurate and true.
- I allow Elevated Tax Pros to capture my sensitive data like personal id, government id, and other information.
- I have read the terms and conditions and privacy policy of Elevated Tax Pros.
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*
Date Signed

MonthDayYear
Date
Spouse Signature
TAXPAYER DOCUMENTS*

STOP HERE!! PLEASE DO NOT CONTINUE UNTIL YOU HAVE ALL DOCUMENTS AVAILABLE.. ID/DRIVERS LICENSE, SOCIAL SECURITY CARDS, W2'S, 1099'S, 1098T'S, MARKETPLACE INSURANCE, IP PINS, OTHER..
Cancelof
Should be Empty:

Elevated Tax Pros Client Intake Form

Banking Details