Client Intake Form

CLIENT INTAKE
Select Your Tax Pro*
Are You A New Client?*

YesNo
Taxpayer Name*

First NameLast NameSuffix
Social Security Number*
Date of Birth*

MonthDayYear
Occupation*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Spouse Information

First NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
Occupation
Email
example@example.com
Phone Number
Please enter a valid phone number.
Please Provide Who You Were Referred By?
Address*

NO P O BOX/ PHYSICAL ADDRESS ONLY

Street Address Line 2

CityState / Province

Postal / Zip Code
PLEASE READ CAREFULLY

I understand that to claim a person as a dependent, they must meet IRS requirements for relationship, age, residency, and support.

By listing a dependent below, I confirm that:

This person meets the IRS definition of a qualifying child or qualifying relative
This person lived with me for more than half of the tax year (unless an exception applies)
I provided more than half of their financial support (if required)
This dependent is not being claimed by another taxpayer unless permitted by IRS rules
I understand that providing false or inaccurate information may result in denial of credits, repayment of refunds, penalties, or audits.
Signature*

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Dependent 1

First NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
Relationship
Is The Dependent Blind/Disabled?

YesNo
Dependent 2

First NameLast NameSuffix
Social Security Number
Date of Birth

MonthDayYear
Relationship
Is The Dependent Blind/Disabled?

YesNo
Dependent 3

First NameLast NameSuffix
Date of Birth

MonthDayYear
Social Security Number
Relationship
Is The Dependent Blind/Disabled?

YesNo
Dependent 4

First NameLast NameSuffix
Date of Birth

MonthDayYear
Social Security Number
Relationship
Is The Dependent Blind/Disabled?

YesNo
IF YOU ARE CLAIMING A DEPENDENT: Please answer the questions below that apply to your relationship with the dependent. As required by the IRS, we must verify that no one else is eligible to claim your dependent other than you.
If you are claiming a niece, nephew, aunt, or uncle: What is your relationship to the dependent? Where are the parents of the dependent (or dependents)?
If you are claiming a son or daughter: Where is the other parent of the dependent (or dependents)? Does the other parent provide any financial support?
If you are claiming a brother or sister: What is your relationship to the dependent? Why are the parents not claiming the dependent (or dependents)?
If low income status. How are you able to provide for the dependents?
Did you pay someone to watch your child/children?

YESNO

CHILDCARE Information

	Provider/Daycare	EIN OR SSN IF PROVIDED	ADDRESS	TOTAL QUALIFIED EXPENSES PAID
CHILDCARE INFO

Are you married?*

YESNO
Did you collect social security or retirement income?

YESNO
Did you purchase health insurance through healthcare.gov marketplace (Obama Care)?*

YesNo
If yes, did you receive a 1095-A Form from the marketplace?

YesNo
Were you ever disallowed the E.I.T.C prior to this year?*

YesNo
Did you receive unemployment compensation (1099-G) regular or PUA last year?*

YESNO
PLEASE READ CAREFULLY

I understand that the American Opportunity Tax Credit (AOTC) has specific IRS eligibility requirements.

By requesting the AOTC, I confirm that the student listed below:

Was enrolled at least half-time in a degree or certificate program at an eligible educational institution
Was pursuing a post-secondary degree or recognized credential
Has not completed four years of post-secondary education before the tax year
Did not claim the AOTC for more than four tax years
Had qualified education expenses paid during the tax year
Was not convicted of a federal or state felony drug offense by the end of the tax year
I understand that inaccurate or incomplete information may result in denial of the credit, repayment of refunds, penalties, or IRS examination.
Signature

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Did you make college tuition payments and received a 1098-T Form last year?*

YESNO

College Information

	Name of College/ University	Were you PT or FT?	How many years have you claimed the AOTC	EIN
COLLEGE INFO

Do you have an IP Pin?*

YESNO
IP Pin
Do you owe any delinquent:*

Child SupportAlimonyStudent LoansBack TaxesState TaxesNone of the above

Self Employment
Business Name
EIN
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Email
example@example.com
Business Phone Number
Please enter a valid phone number.
What is your business entity?

Sole ProprietorLLCNonprofitCorporation
What type of products/services do you offer?
Aprox how many clients did you service in 2025?
What type of expenses do you have?
What type of payments do you take?
If requested could you submit all income and expense documents?
Total business income for 2025:
Total expenses for 2025:
Affidavit for No Receipts OR Profit and Loss Statement
I declare that the above information is true and accurate to the best of my knowledge.

Signed your name for Affidavit for No Receipts OR Profit and Loss Statement

By entering your Schedule C expenses, you certify that all amounts are accurate, complete, and supported by proper records and receipts. You understand that our firm prepares your return based solely on the information you provide, and you accept full responsibility for the accuracy and substantiation of these expense in the event of an IRS or state inquiry.
Signature

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Refund Disbursement and Acknowledgment
How would you like to receive your refund?*

Refund Transfer Direct DepositRefund Transfer Debit CardRefund Transfer Paper Check

Bank Information

	Name of Bank	Routing Number	Account Number
ENTER BANK DATA

Would you like to see if you PRE-QUALIFY for a SAME DAY CASH ADVANCE UP TO $9,600?:

YESNO
How would you like to receive your cash advance refund?:
CLIENT ENGAGEMENT LETTER
Tax Preparation Services

This Client Engagement Letter (“Agreement”) confirms the terms under which B&T Tax Solutions will provide income tax preparation services to you (“Client”).

Scope of Services

B&T Tax Solutions will prepare your federal and, if applicable, state income tax return(s) based solely on the information and documentation you provide. Services are limited to tax preparation only and do not include legal, financial planning, or investment advice.

Refund amounts are estimates only and are not guaranteed.

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Client Responsibilities

You are responsible for providing complete, accurate, and truthful information necessary to prepare your tax return, including all income, expenses, deductions, credits, dependents, and supporting documents.

You acknowledge:

• You reviewed your information for accuracy

• False or incomplete information may result in penalties, audits, delays, or denial of credits

• You remain legally responsible for your tax return

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Due Diligence & Credit Eligibility

Certain credits and filing statuses are subject to strict Internal Revenue Service due-diligence rules. We are required to ask questions and request documentation. Credits may be denied if documentation is insufficient.

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Fees & Payment Terms

Fees are based on complexity and services rendered. Fees are earned once the return is prepared and are non-refundable after preparation or submission. Bank product fees are separate if applicable.

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Refund Timing Disclaimer

Refund timelines are controlled by the IRS and state agencies. The commonly referenced 21-day timeframe is not guaranteed. Delays may occur due to verification or government review.

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Audit Protection

Audit protection is included and covers assistance with IRS or state notices related to the return prepared by B&T Tax Solutions.

Audit protection does not include:

• Fraud or intentional misrepresentation

• Information not disclosed during preparation

• Court appearances or litigation

Additional services may require a separate agreement.

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Termination

We reserve the right to withdraw if information appears false, incomplete, or misleading.

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Client Acknowledgment

IRS Contact: 1-800-829-1040

To check your federal refund status online, you will need your filing status, Social Security number, and the total refund amount before fees.

https://sa.www4.irs.gov/irfof/lang/en/irfofgetstatus.jsp

DUE DILIGENCE DISCLOSURE

IRS Compliance Notice

Federal law requires tax preparers to meet due-diligence standards when preparing returns that include certain credits and filing statuses.

By signing below, you acknowledge:

• You were asked questions to determine eligibility

• You provided truthful and complete information

• You understand credits may be denied if documentation is insufficient

Providing false information may result in penalties, audits, or repayment of credits.
PRIVACY POLICY
Safeguarding Client Information

B&T Tax Solutions is committed to protecting your personal and financial information.

Information We Collect

We collect information necessary to prepare your return, including personal identifiers, income documents, dependent information, and banking details if applicable.

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Use of Information

Information is used solely to:

• Prepare and file tax returns

• Comply with tax laws

• Respond to taxing authorities

• Provide audit protection services

We do not sell or rent your information.

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Disclosure of Information

Information may be disclosed only:

• As permitted or required by law

• To the IRS or state agencies

• To necessary third-party tax processors

• With your written consent (including IRS Form 7216)

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Safeguards

We maintain physical, electronic, and procedural safeguards. Access is limited to authorized personnel only.

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Record Retention

Records are retained per federal and state requirements and securely destroyed thereafter.

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Acknowledgment:
IRS FORM 7216 – CONSENT TO USE & DISCLOSE TAX INFORMATION

(Presented as an embedded DocuSign form) I authorize B&T Tax Solutions to use and disclose my tax return information as permitted by law and for the purpose of preparing and filing my tax return and related services.
Taxpayer Name*
Signature*

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Date

MonthDayYear
Identification*

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Social Security Card

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Head Of Household

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Dependent Birth Certificate or Certificates

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Dependent Social Security Card or Cards

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W2 Forms

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Self Employment

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College Forms

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Healthcare Forms

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IP Pin (paper from the IRS)

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Direct Deposit

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Misc. Forms

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Previous Year Tax Return (2024 Tax Return If Possible)

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CLIENT INTAKE