Clone of Client Intake

Client Intake
WELCOME!

To ensure we have the information we need to best serve you, please take a few moments to fill out the form below. If you have any questions, please feel free to contact us at any time. Thank you!
How did you hear about us?

FacebookInstagramReferralWebsite
If someone referred you, please list his or her name here.
What Tax Professional do you prefer?
Tax Payer's Full Name

First NameLast Name
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Tax Payer's Primary Phone Number
Please enter a valid phone number.
Tax Payer's Secondary Phone Number
Taxpayer must provide 2 contact numbers.
Tax Payer's Date of Birth

MonthDayYear
Tax Payer's Social Security Number
example 000-00-0000
Tax Payer's Email Address
example@example.com
Spouse's Full Name

First NameLast Name
Spouse's' Phone Number
Please enter a valid phone number.
Spouse's Date of Birth

MonthDayYear
Date
Spouse's Social Security Number
example 000-00-0000
Spouse's Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PREFERRED CONTACT METHOD

PHONEEMAILTEXT
Do you have a business or self-employed?

YESNO
How much profit was made in 2025 for your business?
Do your certify the profit made in 2025 is true, accurate and is given to use as a source of income for your 2025 Federal and State Return?

YesNoN/A
Did you incur expenses to materially operate your business in 2025?

YesNoN/A
If so, please provide a complete and accurate 2025 Profit & Loss Worksheet
What is your marital status as of December 2025?

Single(Not Married)Married living with SpouseMarried not living with Spouse
Did you and your spouse live apart during the tax year?

YesNoN/A
Did you pay over half the expenses of maintaining your resident for the entire year of 2025?

YesNo
Did you support a child or family member for more than 6 months out the year?

YesNo
If yes, did you live together at any time after June 30, 2025?

YesNoN/A
How many dependents are you claiming?
Dependent #1 Full Name

First NameLast Name
Dependent #1 Date of Birth

MonthDayYear
Dependent #1 Social Security Number
Example 000-00-0000
What is Dependent #1 Relationship to You? (son, daughter, sibling, etc.)?
How many months did Dependent #1 live with you in 2025 (If all year, enter 12)
Is Dependent #1 Disabled?

YesNo
Dependent #2 Full Name

First NameLast Name
Dependent #2 Date of Birth

MonthDayYear
Dependent #2 Social Security Number
Example 000-00-0000
What is Dependent #2 Relationship to You? (son, daughter, sibling, etc.)?
How many months did Dependent #2 live with you in 2025? (If all year, enter 12)
Is Dependent #2 Disabled?

YesNo
Dependent #3 Full Name

First NameLast Name
Dependent #3 Date of Birth

MonthDayYear
Dependent #3 Social Security Number
Example 000-00-0000
What is Dependent #3 Relationship to You? (son, daughter, sibling, etc.)?
How many months did Dependent #3 live with you in 2025? (If all year, enter 12)
Is Dependent #3 Disabled?

YesNo
Are there any dependents in daycare? If yes, please upload the form you received from the daycare provider.

YesNo
Upload a copy of your daycare form here.

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Did you receive a 1095A or 1095C? (HEALTH INSURANCE MARKETPLACE) If so please provide this form failure to do so the IRS will hold your tax return.
Upload a copy of your 1095A (HEALTH Insurance MarketPlace.

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Did you, or a qualifying child or dependent, attend an eligible college or university and receive Form 1098-T?
Upload Form 1098-T

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Did you receive UNEMPLOYMENT benefits in the year 2025?

YesNo
IF YOU RECIEVED UNEMPLOYMENT BENEFITS IN 2025 YOU MUST REPORT THIS INCOME TO YOUR 2025 FEDERAL AND STATE RETURNS. FAILURE TO DO SO THE IRS WILL HOLD YOUR 2025 TAX REFUND.
UPLOAD YOUR 1099G (UNEMPLOYMENT COMPENSATION FORM)

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Taxpayer's / Spouse's Identification(Drivers License, State ID Card) PLEASE UPLOAD

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Taxpayer's/Spouse's Social Security Card. PLEASE UPLOAD.

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Dependent's Social Security Card. PLEASE UPLOAD

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W-2's, 1099NEC, 1099MISC, 1099-G ,1098T, ETC (PLEASE UPLOAD ALL TAX FORMS)

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How would you like to receive your refund?

Check (Must be picked up in office or Mailed in 24 hours)Refund Advantage Debit Card (Must be picked up in office)Direct Deposit
Would you like to apply for the advance?

YesNo
If Direct Deposit, which type of account would you like your refund deposited into?

Checking AccountSavings Account
Name of Bank?
Routing Number?
Bank Account Number?
I AM GIVING TOP PRIORITY TAX PROS LLC AND/OR ASSOCIATED AFFLIATES PERMISSION TO PREPARE ALL FORMS RELATED TO MY TAX RETURN AND I HAVE SIGNED ALL NECESSARY FORMS TO FILE MY FEDERAL INCOME TAX RETURN ELECTRONICALLY. I TAKE FULLY RESPONSIBILITY FOR THE ACCURACY OF THIS CLIENT INTAKE FORM AND I UNDERSTAND THAT TOP PRIORITY TAX PROS LLC AND/ OR ASSOCIATED AFFIATLES HOLD NO RESPONIBILITY FOR ANY MISREPRESENTATION OR FALSE CLAIMS.

I HEREBY CERTIFY THAT, TO TO THE BEST OF MY KNOWLEDGE, THE PROVIDED INFORMATION IS TRUE AND ACCURATE.
Name

First NameLast Name
Date

MonthDayYear
Date
Signature

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Client Intake

WELCOME!

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