Customer Intake Sheet
Tax Year (s):
Primary Filer's Information
Name
*
First Name
Last Name
Date of Birth
*
Last 4 of SSN #
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Upload copy of Driver's License
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of
W-2
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of
Were you considered married 12/31/2025 ?
Yes
No
Can someone else claim you as a dependent?
Yes
No
Did you have Health Insurance?
Please Select
Yes
No
Dependent's Information
Do you have dependents?
Yes
No
Relationship to Dependent
Please Select
Son
Daughter
Step Child
Sibling
Neice
Nephew
Grand Parent
Grand Child
Mother
Father
Uncle
Aunt
Name of Dependent
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Relationship
Please Select
Name of Dependent
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Relationship
Please Select
Name of Dependent
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Relationship
Please Select
Son
Daughter
Step Child
Sibling
Neice
Nephew
Grand Parent
Grand Child
Mother
Father
Uncle
Aunt
Name of Dependent
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Did your dependent(s) live with you for the full year?
Yes
No
Joint Custody
Did you provide more than 1/2 of the support for your dependent (s)?
Yes
No
Did any of your dependents attend college/trade school
Yes
No
Source of Income. Check the Income Items Which Pertain to You.
Source of Income
*
Wages or Salary (W2 Income)
Unemployment (1099-G)
Pension/Retirement Income (1099-R)
Rental Income (1099-misc)
Farm Income
Dividend/Sale of Stocks (1099-DIV)
1098- T (Tuition)
Cryptocurrency
Source of Income
Interest Income 1099 INT
Self-Employment-Bus. Income (1099-NEC, 1099-K)
Alimony Received
Lottery or Gambling Income W-2G
Public/State Aid Income
Social Security Income
Tips
Other Income
Source of Expenses. Check the Expenses Which Pertain to You
Type of expense
IRA's
Property Tax
Mortgage Points(closing points)
Business Owner/Self Employed
Tax Prep Expenses
Union Dues
Education Expense
Disaster/Loss/Theft/Casualty
Type of expense
Charity of Religous Contributions
Mortgage Investment
Moving Expenses
Medical Expense
Alimony Paid
Buy or Sell Home
Job Related Expenses
Other
If you pay for Child Care- Information
Provider Name
First Name
Last Name
Provider Phone Number
Format: (000) 000-0000.
Provider Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I give Financial permission to electronically deduct final tax fee(s) from my IRS refund (Initial Below)
*
Client Signature
Date
-
Month
-
Day
Year
Date
Spouse Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: