Clone of Authentitax Client Intake Form

1
Do you have a preferred tax preparer?
Please Select
Please Select
No, I dont have a preferred tax preparer
Dani Merritt
Daniel Dukes
2
How did you learn about Authentitax?
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Please Select
Internet Search
Social Media
Friend or Family
Advertisement
Event
Other
3
Referred byPlease list the person you were referred by here
4
Name
Prefix
First Name
Middle Name
Last Name
Suffix
5
I am interested in...Select all that apply
Tax Software
Bookkeeping/Financial Statement Package
Credit Repair
Website Development/CRM
Business Plan/Formation
6
Social Security Number* This field is required.
7
Re-enter Social Security Number* This field is required.
8
Taxpayer Birthday
Date
Month
Day
Year
9
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
10
Email Address* This field is required.
example@example.com
11
Cell Phone Number* This field is required.
Please enter a valid phone number.
12
Do you have an IP PIN?
YESNO
13
Are you married as of 12/31/2025?
Yes
No
Legally Separated
Widowed/Recently Deceased
14
Spouse Name
Prefix
First Name
Middle Name
Last Name
Suffix
15
Spouse Social Security Number
16
Re-enter Spouse Social Security Number
17
Spouse Birthday
Date
Month
Day
Year
18
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
19
Email* This field is required.
example@example.com
20
Cell phone number* This field is required.
Please enter a valid phone number.
21
Does your spouse have an IP PIN?If you answered yes then please answer the questions
YESNO
22
Your Spouse's IP PIN
23
Can you be claimed as a dependent by someone else?
YESNO
24
What is your expected filing status?
Single
Married filing jointly
Married filing seperately
Widow
Head of Household
Dependent on another return
25
Did you receive a refund of EITC or ACTC in 2025 (for 2024 Tax Year) ?
YESNO
26
Did you provide 50% or more expenses for someone that LIVED WITH YOU for more than 6 months in 2025?
YESNO
27
Do you have dependent(s)?
YESNO
28
Additional Dependent Questionnaire
29
Income sourcesSelect all that apply
Wages (W2)
Self Employment/Contractor (1099)
Dividends
Rental/Lease Income
Gambling Earnings
Other
30
ARE YOU SELF-EMPLOYEDIF YES, A LINK TO SELF-EMPLOYED INCOME WORKSHEET WILL BE SENT FOLLOWING SUBMISSION
YESNO
31
Did you earn tips or overtime in 2025?
Yes
No
32
Upload your last pay stub related to tips or overtime
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Select files to upload
Max. file size: 10.0MB
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33
Preferred Refund Method
Prepaid Card (Bank Product)
Direct Deposit
34
Direct Deposit Authorization Form
Bank Name
Routing number
Account number
35
Acknowledgements* This field is required.I (We, if filing jointly) acknowledge that the above information provided by me is true and accurate to the best of my knowledge. I hereby relieve Authentitax, and its agents and affiliates from any liability whatsoever, regarding the preparation of this/these tax returns, and agree to hold harmless from any damages I may suffer and understand that my sole relief is limited to the return of any fee paid for the preparation of these tax documents. I (we) guarantee payment of the preparation fee and any related charges.
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36
Please Upload Front of ID
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Max. file size: 10.6MB
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37
Please Upload Back of ID
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Max. file size: 10.6MB
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38
Please Upload W-2's
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Max. file size: 10.6MB
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39
Please Upload 1099 Documents
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Max. file size: 10.6MB
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40
Upload Social Security Card
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Max. file size: 10.6MB
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41
Upload Prior Year (2024) Tax Return
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Max. file size: 10.6MB
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42
Please Upload Any other Documents HereUpload last pay stub, 1098 statements, or any other tax related documents here
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Select files to upload
Max. file size: 10.6MB
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43
Acknowledgement* This field is required.I (We, if filing jointly) acknowledge that the above information provided by me is true and accurate to the best of my knowledge. I hereby relieve Authentitax, and its agents and affiliates, from any liability whatsoever, regarding the preparation of this/these tax return, and agree to hold them harmless from any damages I may suffer and understand that my sole relief is limited due to false or incomplete preparation if these tax documents are submitted. I (we) guarantee an accurate account of information provided for 2025 tax preparation.
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