Elevated Tax Pros Client Intake Form
Filing Status
*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Name
*
First Name
Last 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
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
*
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Are you legally blind?
Yes
No
Spouse Information
Name
First Name
Last 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
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they legally blind?
Yes
No
Are they your dependent?
Yes
No
Dependents
Enter your dependents here
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.
*
Yes/No
Employer
Spouse Ins
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Dependent 4
Yes
No
Dependent 5
Yes
No
Tax Related Questions
Employment Status
*
Employed
Self-employed
Are you contributing to 401k or other pre-tax account?
Yes
No
Does your dependents have tuition expenses?
Yes
No
Do you have any expenses for child care?
Yes
No
Are you currently renting?
Yes
No
What is the monthly rental amount?
How long have you lived at the property?
# of months
Do you have your own home?
Yes
No
Do you have documents that shows you paid for property taxes?
Yes
No
Did you take money from your 401k?
Yes
No
Did you work overtime?
Yes
No
Do you have mortgage interest?
Yes
No
Do you have real estate tax?
Yes
No
Are you a victim of identity theft?
*
Yes
No
Audited by the IRS last year?
*
Yes
No
Did you file with us last year?
Yes
NO
Do you owe the IRS?
*
Yes
No
Im not sure
Would you like to apply for a loan? (loans are available same day, up to $7500)
*
Yes
No
Would you like to receive 1 complementary round of credit repair?
*
Self Employed Information
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
*
Acknowledgment & Signature
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
*
-
Month
-
Day
Year
Date
Taxpayer Signature
*
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
TAXPAYER DOCUMENTS
*
Browse Files
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ID/DRIVERS LICENSE, SOCIAL SECURITY CARDS, W2'S, 1099'S, 1098T'S, MARKETPLACE INSURANCE, IP PINS, OTHER..
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