TAX CLIENT INTAKE
Thank you for taking time to complete. This information is critical to ensure that we accurately file your tax return.
Filing Status
*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Did you pay more than half your household bills this year?
*
Yes
No
Do you want to opt into a refund advance up to $7,000?
*
Yes
No
Were you referred? If so, who referred you?
Taxpayer Information
Name
*
First Name
Last Name
Social Security Number
*
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
Was your address different from last year tax return?
*
Yes
No
Are you over age 18 and a full-time student?
*
Yes
No
Are you legally blind?
*
Yes
No
Are you a veteran?
*
Yes
No
Dependents (only use if applies to you)
Enter your dependents here
Rows
Name
Date of Birth
Relationship
Social Security Number
1
2
3
4
5
6
Did your dependent(s) live with you more than 6 months out of the year?
Yes
No
Are any dependent(s) currently, or intended to be, a qualifying child on any other individual's tax return?
Yes
No
Tax Related Questions (applies to all)
Employment Status
*
Employed
Unemployed
Self-employed
Occupation
Forms to file
*
W-2(s)
1099(s)
Unemployment
Other
Last years refund amount?
Do you have IP-PIN?
*
Yes
No
IP-PIN
Did you, or a dependent have insurance under the Affordable Care Act?
*
Yes
No
Were any credits disallowed or reduced in a previous year?
*
Yes
No
Additional comments
Refund Method (applies to all)
Bank name
*
Routing number
*
Account number
*
Account type (Checking/ Savings)
*
Document Upload (applies to all)
File Upload : Photo Identification
*
Browse Files
Drag and drop files here
Choose a file
Upload all documents to be included in preparations. If more information is needed you will be contacted.
Cancel
of
File Upload : Social Security Card(s) taxpayer &/or dependent(s)
*
Browse Files
Drag and drop files here
Choose a file
Upload all documents to be included in preparations. If more information is needed you will be contacted.
Cancel
of
File Upload: Dependent(s) Birth Certificate(s)
Browse Files
Drag and drop files here
Choose a file
Upload all documents to be included in preparations. If more information is needed you will be contacted.
Cancel
of
File Upload: Head of Household (Lease, Utility Bill, or Mortgage Statement)
Browse Files
Drag and drop files here
Choose a file
Upload all documents to be included in preparations. If more information is needed you will be contacted.
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of
File Upload: ANY IRS FORMS ( W-2(s), 1099(s), 1098(s), etc. )
*
Browse Files
Drag and drop files here
Choose a file
Upload all documents to be included in preparations. If more information is needed you will be contacted.
Cancel
of
File Upload: Self-employed business income records, expense receipts, mileage logs, etc.
Browse Files
Drag and drop files here
Choose a file
Upload all documents to be included in preparations. If more information is needed you will be contacted.
Cancel
of
Acknowledgment & Signature (applies to all)
I confirmed that all information I entered here is accurate and true.
I allow Rich Empire Tax Software to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of Rich Empire Tax Software.
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
*
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Submit
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