Tax Preparation Client Intake Form
Please complete client intake form and upload all documents please be advised that we will not submit anything without taxpayers signature and date of approval all uploaded information and documents are safe and secure
Name
*
First Name
Last Name
Filing Status
*
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Age
*
Date of Birth
*
-
Month
-
Day
Year
Date
Social Security Number
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
*
Are you a full-time student?
*
Yes
No
Are you totally and permanently disabled?
*
Yes
No
Are you legally blind?
*
Yes
No
Spouse Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Social Security Number
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Are they a full-time student?
Yes
No
Are they legally blind?
Yes
No
Are you totally or permanently disabled?
Yes
No
Dependents
Enter your dependents here
Rows
Name
Date of Birth
Social Security Number
Relantionship
Number of months Lived with
Full Time Student
1
2
3
Tax Related Questions
Do you or anyone in household owe IRS, Student Loans, Child Support or any offsets?
*
Yes
No
Did you receive any unemployment benefits?
*
Yes
No
Do your dependents have tuition expenses?
*
Yes
No
Do you have any expenses for child care?
*
Yes
No
Did you take money from your 401?
*
Yes
No
If filing Business return, can you provide documents to prove your business expenses and income?
*
Yes, please upload all business documents, invoices, statements, expenses, receipts.
No
N/A
Did you have Health Insurance through the Marketplace/ObamaCare?
Yes
No
Unsure please call with more information
UPLOAD TAX FORMS
Tax Documents: W2s, 1099s, Business Income etc.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Driver's license Photo ID of all Adults
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
All persons Social Sercurity Cards
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Proof of address lease utility bill etc.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Expenses: childcare, college credits 1098T
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Direct Deposit Information
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Misc:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Additional comments
Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow 4Them Tax Services to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of 4Them Tax Services.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Are you applying for an Electronic Refund Transfer where the IRS will send refund to bank and your preparer will be paid out of refund and remaining balance your owed will be paid to you the taxpayer
*
Yes
No
Will Pay Fees Upfront
Are you applying for an Advance? Advances are up to $7,000 and available within 1 hour pending you are approved. There is no guaranteed amount, and it is not based off of your credit profile. advances are repaid from your tax refund when it is funded by the IRS.
Yes
No
Unsure, call me with more information
ENGAGEMENT LETTER:
This form is to confirm and specify the terms of our engagement with you and to clarify the nature and extent of the services we will provide. In order to ensure an understanding of our mutual responsibilities, we ask all clients for whom returns are prepared to confirm the following arrangements. By providing us with your signature, you are accepting the terms and conditions specified on this form. We will prepare your TAX YEAR(S) federal, state and local income tax returns from information which you will furnish to us. We will not audit or otherwise verify the data you submit, although it may be necessary to ask you for clarification of some of the information. We will furnish you with questionnaires and worksheets to guide you in gathering the necessary information. We reserve the right to assess additional bookkeeping charges. It is your responsibility to provide all the information required for the preparation of complete and accurate returns. You should retain all the documents, cancelled checks and other data that form the basis of income, expenses, credits and deductions. These may be necessary to prove the accuracy and completeness of the returns to a taxing authority. You have the final responsibility for the income tax returns and, therefore, you should review them carefully before you sign them. Our work in connection with the preparation of your income tax returns does not include any procedures designed to discover defalcations and/or irregularities, should any exist. We will render such bookkeeping assistance as determined to be necessary for preparation of the income tax returns. The law provides various penalties that may be imposed when taxpayers understate their tax liability. If you would like information on the amount or the circumstances of these penalties, please view the IRS website. Your returns may be selected for review by the taxing authorities. Any proposed adjustments by the examining agent are subject to certain rights of appeal. You are in full agreement with 4Them TAX completing your tax return and making sure that your return is filed with all of the available deductions given your filing circumstances. Since your tax return is unique to your circumstances, we CANNOT GUARANTEE the outcome of what happens after your return is sent to the IRS. If your return is used to fulfill an offset, this DOES NOT RELIEVE YOU OF YOUR OBLIGATION TO PAY for services provided. I have given authorization/permission to my preparer with 4Them TAX to file a wages informational return on my behalf to the IRS, this includes 1099NEC or a 1099MISC.*** If the above sets forth your understanding, please sign this form in the space indicated. This form will apply for all tax returns prepared for you by our tax preparers. 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. I understand that 4ThemTAX is only liable for any Error and Omission on their part and will be responsible for any interest and penalties and not tax due. ARBITRATION If a dispute arises out of or relates to this contract or engagement letter, or the obligations of the parties therein, and if the dispute cannot be settled through negotiation, the parties agree first to try in good faith to settle the dispute by mediation administered by the American Arbitration Association under its commercial Mediation Rules before resorting to arbitration, litigation, or some other dispute resolution procedure.
How Did you hear about 4Them Tax Service
referred by
Date Signed
*
-
Month
-
Day
Year
Date
Taxpayer Signature
*
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
Is it really you? You must provide your tax preparer with a LIVE photo of yourself
*
Print
Save
Submit
Submit
Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?
*
Rows
Yes/No
Employer
Spouse Ins
Exchange/ Marketplace
Direct with Insurer
Medicare
Medicaid
Taxpayer
Yes
No
Spouse
Yes
No
Dependent 1
Yes
No
Dependent 2
Yes
No
Dependent 3
Yes
No
Should be Empty: