Client Intake Form

Client Intake Form

Thank you for choosing U.P.A. to handle your taxes with precision. Please complete this secure form so we can get started.
Filing Status
- Full Name
  
  First NameMiddle NameLast Name
- Date of Birth
  
  MonthDayYear
  Date
- Social Security Number
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Email Address
  example@example.com
- IP PIN (If applicable)
- Mailing Address
  
  Street Address
  
  Street Address Line 2
  CityState / ProvincePostal / Zip Code
- If “MFJ or MFS” was selected in the filing status, please add Spouse information
- Spouse Full Name
  
  First NameMiddle NameLast Name
- Spouse Date of Birth
  
  MonthDayYear
  Date
- Spouse Social Security Number
- Spouse Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Spouse Email Address
  example@example.com
- Spouse IP PIN (If applicable)
- Please upload your Drivers License or Identification Card (upload spouse DL/ID if applicable)
  
  Cancelof
- Please upload your social security card (upload spouse SSN if applicable)
  
  Cancelof
- Do you have Dependents?
- Number of Dependents
- Dependent 1 Full Name
  
  First NameMiddle NameLast Name
- Dependent 1 Date of Birth
  
  MonthDayYear
  Date
- Dependent 1 Social Security Number
- Dependent 1 Gender
- Dependent 2 Full Name
  
  First NameMiddle NameLast Name
- Dependent 2 Date of Birth
  
  MonthDayYear
  Date
- Dependent 2 Social Security Number
- Dependent 2 Gender
- Dependent 3 Full Name
  
  First NameMiddle NameLast Name
- Dependent 3 Date of Birth
  
  MonthDayYear
  Date
- Dependent 3 Social Security Number
- Dependent 3 Gender
- What are your relationship to the Dependent(s)?
- Have they lived with you for more than half the year?
- Upload the Dependent(s) Social Security Card (if applicable)
  
  Cancelof
- Upload the Dependent(s) Birth Certificate (if applicable)
  
  Cancelof
- Upload the Dependent(s) School/Medical Records (if applicable)
  
  Cancelof
- Check all that apply:
- Please upload all the income sources you checked above
  
  Cancelof
- Check all that apply:
- Please upload all the deductions & credits you checked above
  
  Cancelof
- Did you file taxes last year?
- If no, please upload the necessary documents for us to assist (Income wages, Dependents, deductions, etc)
  
  Cancelof
- Do you owe back taxes, child support, or other debts?
- If Yes, please specify amount/type
- How to receive your refund?
- Bank Name (if Direct Deposit)
- Account Type: (if Direct Deposit)
- Routing Number: (if Direct Deposit)
- Account Number: (if Direct Deposit)
- Referrals: (First & Last Name, phone Number)
- Any Other Additional Comments:
- •U.P.A. provides free estimates before filing.
  
  •Once your return is accepted by the IRS, it cannot be changed or withdrawn.
  
  •If your refund is offset (student loans, child support, or other obligations), you are still responsible for U.P.A.’s filing fees. Failure to pay may result in legal action.
  
  • You authorize U.P.A. to securely capture and store sensitive personal information as required to complete your tax return (SSN, ID, Tax Docs, etc.)
  
  •By signing below, you acknowledge that you have read and agree to U.P.A.’s Terms & Conditions and Privacy Policy.
  
  •By submitting the client intake form, you confirm that all information provided is accurate and true to the best of your knowledge.
- Date
  
  MonthDayYear
  Date
- Signature
- Should be Empty: