CJ's Financial Services-Tax Client Intake Form

Tax Client Intake Form

Please Fill out all Required Fields.
Let's start with your personal information.

This section collects your basic details for tax filing.
What is your tax filing status?*

SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow(er)Other
Full Name*

First NameLast Name
Social Security Number
Enter your Social Security Number
Date of Birth

MonthDayYear
Date
What is your current residential address?*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Occupation
Email Address*
example@example.com
Phone Number
Please enter a valid phone number.
Where you referred?

YesNo
Who Referred You?
Spouse Name

First NameLast Name
Spouse Social Security Number
Enter your Spouse's Social Security Number
Spouse Date of Birth

MonthDayYear
Date
Spouse Email
example@example.com
Spouse Phone Number
Please enter a valid phone number.
Please select all sources of income you received this year.

Employment IncomeSelf-Employment IncomeRental IncomeInvestment IncomeRetirement IncomeSocial Security BenefitsUnemployment BenefitsAlimonyChild SupportOtherOther
Upload any relevant tax documents (e.g., W-2s, 1099s, receipts, proof of deductions).

Upload a File

Cancelof
Do you have any dependents to claim this year?*

YesNo
If yes, please provide the names, relationship, SSN, and the D.O.B of your dependents.
Did you have Marketplace insurance?

YesNo
Upload 1095-A Form

Upload a File
Please upload your 1095-A form if applicable Cancelof
Do you have an IP PIN?

YesNo
IP PIN Number
Do you owe the IRS?

YesNo
Upload your State ID

Upload a File
Please upload your State ID Cancelof
Banking Information
Should be Empty:

Tax Client Intake Form

Let's start with your personal information.