HOUSE OF FINANCE Tax Solutions Client Intake Form
PLEASE DO NOT FORGET TO UPLOAD A DRIVERS LICENSE OR ID FOR THE TAXPAYER AND TWO FORMS OF ID FOR EACH DEPENDENT. ACCEPTABLE FORMS OF ID ARE SOCIAL SECURITY CARD, BIRTH CERTIFICATE, MEDICAL RECORD, SCHOOL RECORD, SHOT RECORD, LAST YEAR TAX RETURN (DEPENDENT MUST BE FILED ON THE RETURN), AND LEASE AGREEMENT
Full Name
*
First Name
Last Name
Full Name of Spouse
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
example@example.com
Spouse's Email Address
example@example.com
Date of Birth
Who referred you?
Filing Status
Single
Head of Household
Married filing joint
Married filing separately
Social Security Number
Spouse's Social Security Number
Phone Number
Spouses Phone Number
Please enter a valid phone number.
Check All that Applies
W2
Schedule C/Business Income
Household Income
School
Are you a recipient of Obama Care or did you purchase Medical Insurance from the federal marketplace? If so, please provide form 1095A in the upload section at the bottom of this application:
Yes
No
How many dependents?
Dependent 1 Name
Relationship with dependent (daughter, son, sister, brother)
Dependent 1 Social Security Number
Sex of Dependent
Female
Male
Dependents Date of Birth:
Is the child disabled?
Do you provide more than 50% support?
Has the dependent lived with you at lease half of the year?
Yes
No
Dependent 2 Name:
Relationship with Dependent 2: (daughter, son, sister, brother)
Dependent 2 Social Security Number
Dependent 2 Date of Birth:
Sex of Dependent
Female
Male
Is the child disabled?
Yes
No
Do you provide more than 50% support?
Has the dependent lived with you at least half of the year?
Dependent 3 Name
Relationship with Dependent 3 (daughter, son, sister, brother)
Dependent 3 Social Security Number
Dependent 3 Date of Birth:
Do you provide more than 50% support?
Sex of Dependent (male or female)
Has the dependent lived with you at least half of the year?
Phone Number
*
Did you pay any child care expenses last year?
How much did you pay in child care expenses?
Please provide the name, address, and social security number or EIN # of your Childcare provider
Occupation/Title
Do you receive Social security benefits? If you do, we want to ensure that you stay within the income guidelines to continue receiving your benefits.
Yes
No
Type a question
AGI (Total Wages/Earned Income (Box 1 on W2)
*
Federal Withheld (Box 2 on W2)
Do you have business income or any other source of income? If yes, please indicate what type of business you have in the line below.
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Gross Amount of Annual Business Income Collected in 2024 Tax Year
Please select documents you have provided for proof of loss/profit for business/self employment
Written Ledger
Receipts
Bank Statements
Invoices
Do you want a cash advance?
How would you like to collect your Refund?
Please Select
Direct Deposit
Paper Check
Cash Advance
Bank Name
Would you like your refund deposited into your checking or savings account?
Please Select
Checking
Savings
Direct Deposit Routing #: (Required if Direct Deposit was selected, please double check information)
Direct Deposit Account# (Required if Direct Deposit was selected, please double check information)
UPLOAD DRIVERS LICENSE OR STATE ID
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UPLOAD DEPENDENT'S FORM OF ID - SOCIAL SECURITY CARD, BIRTH CERTIFICATE, SCHOOL RECORD, OR MEDICAL RECORD
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UPLOAD W2'S
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The signature below confirms that all information provided is true and accurate. The data has been filled out by me; without any assistance from my tax preparer.
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