Intake Form( New Client)

Intake Form
About You
Name

First NameMiddle NameLast Name
Social Security Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date Of Birth

MonthDayYear
Date
ID Issue Date

MonthDayYear
Date
NoYes
ID expired Date
NoYes
If you answered "YES" please enter the full name of the person who referred you.

Taxpayer W2's

Cancelof
Last 2 Paystubs

Pre Advance Loans Only
Cancelof
Taxpayer 1098

Cancelof
Taxpayer 1099's

Cancelof
Spouse W2's

Cancelof
Spouse 1099's

Cancelof
Spouse 1098

Cancelof
Spouse Additional Documents

Cancelof
YesNo
1099-G (Unemployment Form)

Cancelof
YesNo
Any Additional Documents

Cancelof

Health Care
YesNo
Health Care Documents

Cancelof
YesNo
Health Care Documents

Cancelof
Getting Your Refund
Tax Refund Disbursement Method
Bank Name*
Bank Routing Number *
Account Number*
YesNo
How would you like receive your refund?
Earned Income Tax Credit Acknowledgement
I acknowledge that all information refgarding any dependents is true and correct to the best of my knowlegde
Relationship
- Your son, daughter, adopted child, stepchild, foster child or a descendent of any of them such as your grandchild
- Brother, sister, half-brother, half-sister, step brother, step sister or a descendant of any of them such as a niece or nephew
Age
- At the end of the filing year, your child was younger than you (or your spouse if you file a joint return) and younger than 19
- At the end of the filing year, your child was younger than you (or your spouse if you file a joint return) younger than 24 and a full-time student
- At the end of the filing year, your child was any age and permanently and totally disabled
Residency
- Child must live with you (or your spouse if you file a joint return) in the United States for more than half of the year
Joint Return
- The child cannot file a joint return for the tax year unless the child and the child's spouse did not have a separate filing requirement and filed the joint return only to claim a refund.
Please Note: Only one person can claim the same child. If a child qualifies for more than one person and one of the persons is a parent or parents, the non-parent can claim the child only if their AGI is higher than the parent(s). If the child qualifies another relative and the parent AGI rules do not apply, the taxpayers choose. If more than one person claims the same child, IRS applies the tiebreaker rules.
Signature*
By signing this form, I acknowledge that all information regarding any dependents that allows me to qualify for the EITC credit is true and correct to the best of my knowledge. I understand that this information is being provided to the IRS and State Revenue. I have been advised by my tax preparer that any false and misleading information that I provide for income tax filing purposes is against the law and are subject to penalties.
Should be Empty:

Intake Form

About You

Health Care

Getting Your Refund

Earned Income Tax Credit Acknowledgement