Upscale Client Intake Form

Taxpayer’s full name

First NameMiddle Name
Last Name
Taxpayer’s Social Security Number
Taxpayer’s Date of Birth

MonthDayYear
Date
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Will anyone claim you or your spouse as a dependent on their tax return?
Were you or your spouse a full-time college student in 2025? If yes, please upload 1098-T form below
File Upload

Cancelof
Were you or anyone in your household enrolled in health insurance through the marketplace? If yes, please attach 1095-A below
File Upload

Cancelof
Were you issued an identity protection PIN number by the IRS? If yes, please provide pin number
Identity Protection Pin Number

Enter your dependents here

- I confirmed that all information I entered here is accurate and true.
- I allow Brisonia Belance to capture my sensitive data like personal id, government id, and other information.
- I have read the terms and conditions and privacy policy of Upscale Accounting Firm.
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed

MonthDayYear
Date
Taxpayer Signature
Date Signed

MonthDayYear
Date
Spouse Signature
Should be Empty: