2025 Tax Service Client Intake

2025 Tax Year

Please fill out the form accurately. Fields with * are required and must be filled. This form is for tax year 2025 (filed in 2026).
How did you hear about us?*
Who referred you?*
TAXPAYER INFORMATION
Which filing status applies to you?*
# of Dependents*
PLEASE NOTE: Head of Household filers must present a lease, utility bill, or mortgage statement as proof.
First Name*
Middle Name*
Last Name*
Suffix (if applicable)
Date of Birth *

MonthDayYear
Social Security #*
Email*
example@example.com
Phone Number*

Area codePhone number
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
Employer (primary)*
Occupation (primary)*
Check all that apply

Full-time studentPermanantely DisabledLegally BlindDependent of OthersNone apply to me
SPOUSE INFORMATION
Spouse First Name*
Spouse Middle Name*
Spouse Last Name*
Spouse Suffix (if applicable)
Spouse Date of Birth *

MonthDayYear
Spouse Social Security #*
Spouse Email*
example@example.com
Spouse Phone Number*

Area codePhone number
Spouse Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
Spouse Employer (if applicable)
Spouse Occupation (if applicable)
Check all that apply to spouse

Full-time studentPermanantely DisabledLegally BlindDependent of OthersNone apply to spouse
DEPENDENTS INFORMATION
Dependent 1 Name*

First NameMiddle NameLast NameSuffix
Dependent 1 Date of Birth*

MonthDayYear
Dependent 1 Social Security #*
Does other parent provide any financial support for Dependent 1?*
Dependent 1 Relationship to you*
Dependent 2 Name*

First NameMiddle NameLast NameSuffix
Dependent 2 Date of Birth*

MonthDayYear
Dependent 2 Social Security #*
Does other parent provide any financial support for Dependent 2?*
Dependent 2 Relationship to you*
Dependent 3 Name*

First NameMiddle NameLast NameSuffix
Dependent 3 Date of Birth*

MonthDayYear
Dependent 3 Social Security #*
Does other parent provide any financial support for Dependent 3?*
Dependent 3 Relationship to you*
Dependent 4 Name*

First NameMiddle NameLast NameSuffix
Dependent 4 Date of Birth*

MonthDayYear
Dependent 4 Social Security #*
Does other parent provide any financial support for Dependent 4?*
Dependent 4 Relationship to you*
Dependent 5 Name*

First NameMiddle NameLast NameSuffix
Dependent 5 Date of Birth*

MonthDayYear
Dependent 5 Social Security #*
Does other parent provide any financial support for Dependent 5?*
Dependent 5 Relationship to you*
If low income, how are you able to provide for dependent(s)?
TAX SPECIFIC QUESTIONS
Did you pay any child care expenses?*

YesNo
Did you pay any tuition expenses for yourself or any dependent and received a 1098-T form?*

YesNo
Did you purchase health insurance through government marketplace insurance (Obama Care)?*

YesNo
Did you receive a 1095-A form from the marketplace?*

YesNo
Did you receive any social security or retirement income?*

YesNo
Do you have a 401K account?*

YesNo
Did you make a withdrawal from your 401K account?*

YesNo
Did you receive unemployment compensation and receive a 1099-G form?*

YesNo
Which one applies to your unemployment compensation?*

RegularPUANot sure
Do you have any other income (freelance work, gambling, etc)?*

YesNo
Did you receive a 1099-NEC (freelance work) and/or W-2G form (gambling winnings)?*

YesNo
Are you delinquent in any of the following? (you can choose multiple)*

Child supportAlimonyStudent loansFederal taxesState taxesNot applicable
Are you interested in a tax refund advance?*

YesNoNot sure
Do you have an IP pin?*

YesNoNot sure
What is your IP pin?
How would you like to receive your refund?

Direct Deposit (directly into bank account)Refund Debit Card (issued by our bank partner)Paper Check (issued by our bank partner)Not sure
Name of Bank*
Routing Number*
Re-enter Routing Number*
Account Number*
Re-enter Account Number*
REQUIRED DOCUMENTS
Head of Household Proof (Lease, Utility Bill, Mortgage Statement)*

Cancelof
Driver's License / ID card*

Cancelof
Social Security Card*

Cancelof
Dependent(s) Birth Certificate(s)

Cancelof
Dependent(s) Social Security Cards(s)

Cancelof
W-2(s)

Cancelof
1099(s) (Self-Employed, Gambling Winnings, etc.)

Cancelof
Child Care Annual Statement (from facility) or W-10 (for babysitter, nanny)

Cancelof
1098(s) (Tuition / Education Expenses)

Cancelof
1095(s) (Healthcare)

Cancelof
Direct Deposit

Cancelof
IP Pin (IRS document)

Cancelof
Previous Year Tax Return (if available)

Cancelof
Misc. Forms

Cancelof
Take Selfie with your ID next to your face*
Signature*
*
Please verify that you are human*
Should be Empty:

2025 Tax Year