BME TAX SERVICE
Virtual Tax Preparation
CLIENT INTAKE & ENGAGEMENT AGREEMENT
SECTION 1: TAXPAYER INFORMATION
Full Legal Name:
Email Address:
example@example.com
Primary Phone Number:
Format: (000) 000-0000.
Alternate Phone Number:
Format: (000) 000-0000.
Current Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth:
-
Month
-
Day
Year
Date
Upload Photo ID – Front
*
Upload Photo ID – Back
*
Social Security Number (SSN):
Upload Social Security Card
*
SECTION 2: INCOME INFORMATION
Number of W-2s:
Upload W-2s:
Number of 1099s:
Upload 1099s:
Were you referred?
Yes
No
Referral Name:
SECTION 3: REFUND INFORMATION
Refund Method:
Direct Deposit
Check
Bank Name:
Routing Number:
Account Number:
I confirm all banking information is correct.
SECTION 4: BUSINESS / SELF-EMPLOYMENT
Were you self-employed or own a business?
Yes
No
EIN (if applicable):
Gross Business Income:
Do you have a Profit & Loss Statement?
Yes
No
Did you incur business expenses?
Yes
No
N/A
Upload Supporting Documents
I certify all business information is accurate.
SECTION 5: FILING STATUS & HOUSEHOLD
Filing Status:
Single
MFJ
MFS
HOH
Qualifying Widow(er)
Did you live apart from spouse?
Yes
No
N/A
Paid over half cost of home?
Yes
No
Can anyone claim you?
Yes
No
Supported a dependent over 6 months?
Yes
No
Number of dependents:
Dependents in daycare?
Yes
No
SECTION 6: HEALTH INSURANCE
Did you have insurance all year?
Yes
No
Did dependents have insurance?
Yes
No
N/A
Did you receive Form 1095-A?
Yes
No
N/A
SECTION 7: EDUCATION & CREDITS
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Ever denied EITC?
Yes
No
Did you attend college?
Yes
No
Did spouse attend college?
Yes
No
N/A
Do you have Form 1098-T?
Yes
No
N/A
SECTION 8: PRIOR YEAR
Do you have last year's tax return?
Yes
No
N/A
SECTION 9: DOCUMENT CHECKLIST
Photo ID (Front & Back)
Social Security Card
W-2(s) / 1099(s)
Supporting Documents
SECTION 10: PREPARER INFORMATION
Assigned Tax Preparer Name:
ENGAGEMENT AGREEMENT & DISCLOSURES
Engagement & Scope of Services
By submitting this form, I engage BME Tax Services to prepare my federal and applicable state income tax returns based solely on information I provide. Services do not include audit representation, legal advice, or tax planning unless agreed to in writing.
Client Responsibility
I certify that all information provided is true, complete, and accurate. I understand I am legally responsible for my tax return and agree to review it before filing.
IRS Circular 230 Disclosure
Any tax advice provided is not intended or written to be used to avoid penalties under the Internal Revenue Code.
Electronic Filing & Virtual Services Consent
I authorize electronic filing and consent to electronic communication and legally binding electronic signatures.
Privacy & Data Protection Notice
BME Tax Services complies with the Gramm-Leach-Bliley Act (GLBA), IRS Publication 1345, and the IRS Safeguards Rule. Information is protected and used solely for tax preparation services.
Identity Verification
I understand identity verification may be required to comply with IRS regulations.
Record Retention
Copies of records may be retained as required by law. Original documents remain the client's responsibility.
Limitation of Liability
BME Tax Services is not responsible for penalties or interest resulting from inaccurate or incomplete information provided by the client, to the extent permitted by law.
Governing Law
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This agreement is governed by the laws of the State of Texas.
CLIENT ACKNOWLEDGMENTS
I confirm all information is accurate
I agree to the Engagement Agreement
I consent to electronic filing and communication
I acknowledge the Privacy Notice
Client Signature:
Date:
-
Month
-
Day
Year
Date
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