Tax Client Intake Form

Tax Client Intake Form

Essential information from new and returning tax clients
Full Name

First NameMiddle NameLast NameSuffix
Occupation
Social security number
Date of birth

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

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Preferred Method of Contact
Marital Status
If married did your spouse live with you during the last 6 months of the year?
Spouses name

First NameMiddle NameLast NameSuffix
Occupation
Social security number
Date of birth

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

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Preferred Method of Contact
Did you pay over half the cost of keeping up your home?
Do you, your spouse, or any of your dependents have an IP-PIN?
Can you, your spouse, or any dependents be claimed on anyone else's tax return? Please specify below.
What forms are you submitting and how many of each?
W2s, 1099s, 1099SSA, 1099NEC, 1099-R, ETC
Did you or anyone in the household receive a 1095-A or have insurance through the healthcare marketplace?
Did anyone receive Form 1099k from such sources such as VENMO, PAYPAL, or EBAY?
Did anyone have a home interest form?
Did anyone pay sales tax on the purchase of a vehicle?
Did anyone receive unemployment? Please specify below.
Did anyone receive tip/overtime income? Please specify below.
Did you pay for childcare for any of your dependents?
Was anyone in the household a student last year?
Did you donate to any charities last year?
Number of dependents
Dependent 1

First NameMiddle NameLast NameSuffix
Date of birth

MonthDayYear
Date
Social security number
Relationship to you
Was your home the dependents main home for more than 6 months of the year?
Dependent 2

First NameMiddle NameLast NameSuffix
Date of birth

MonthDayYear
Date
Social security number
Relationship to you
Was your home the dependents main home for more than 6 months of the year?
Do you have any other dependents? If so please provide their information.
How would you like your refund issued to you? If by direct deposit please provide your bank name, account, and routing information.
How are you covering your tax fees?
Please share any additional information or specific tax concerns you would like us to know.
I CERTIFY THAT I WOULD LIKE MY TAXES PREPARED ACCORDING TO THE INFORMATION I SUPPLIED.
Signature of taxpayer
Signature of spouse
Should be Empty: