Tax Preparation Client Intake Form
You Must provide your W-2 form. We do not accept the last check stub as a substitute
DID WE DO YOUR TAXES LAST YEAR?
*
YES
NO
NEW CLIENT WHO REFERRED YOU?
Filing Status
Single
Head of Household
Married Filing Separate
Married Filing Joint
Qualifying Widower
Taxpayer Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
DRIVER LICENSE/ID NUMBER/ STATE
Social Security Number
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
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Social Security Number
Email
example@example.com
PHONE CARRIER
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Are they a full-time student?
Yes
No
Are they totally and permanently disabled?
Yes
No
Are they your dependent?
Yes
No
Dependents
Enter your dependents here
Rows
Name
Date of Birth
Relationship
Social Security Number
1
2
3
4
5
6
Please have your W2 if you're employed.
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
Dependent 4
Yes
No
Dependent 5
Yes
No
Tax Related Questions
Employment Status
Employed
Unemployed
Self-employed
Are you contributing to 401k or other pre-tax account?
Yes
No
Does your dependents have tuition expenses?
Yes
No
Do you have mortgage interest?
Yes
No
Did you receive a federal tax last year?
Yes
No
Are you a victim of identity theft?
Yes
No
DO YOU HAVE AN IP PIN
YES
NO
IF YES WHATS THE NUMBER_________________________________________
DID YOU HAVE THE PATIENT AND AFFORDABLE CARE ACT INSURANCE ALSO KNOW AS OBAMA CARE YES OR NO
YES
NO
BANK ACCOUNT ACCOUNT AND ROUTING NUMBERS OR CHECK
Please fill-up the information within the current year only.
Additional comments
File Upload Please upload documents, including w-2s driver license ss cards & any other correspondence, You're trying to file
Browse Files
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Acknowledgment & Signature
I confirmed that all information I entered here is accurate and true.
I allow ABC Financial to capture my sensitive data like personal id, government id, and other information.
I have read the terms and conditions and privacy policy of ABC Financial.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed
-
Month
-
Day
Year
Date
Taxpayer Signature
Date Signed
-
Month
-
Day
Year
Date
Spouse Signature
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