Pro Tax Genie Network Client Intake Form

Pro Tax Genie Network Client Intake Form

Tax Professional
Taxpayer Legal Full Name:*

First NameMiddle NameLast Name
Taxpayer Date of Birth:*

MonthDayYear
Date
Do you have an IPIN?
IRS Identity Protection PIN
Taxpayer Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Taxpayer Email:*
example@example.com
Taxpayer Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
YesNo
Document Upload*

Taxpayer/Spouse: Upload Photo of Driver's License/Identification & SS Card
Cancelof
- Spouse Legal Full Name:
  
  First NameMiddle NameLast Name
- Spouse Date of Birth:
  
  MonthDayYear
  Date
- Spouse Phone Number:
  Please enter a valid phone number.Format: (000) 000-0000.
- Spouse Email:
  example@example.com
- Do Spouse have an IPIN?
  IRS Identity Protection PIN
- Number Of Dependents:
- Dependent Full Name: *
  
  First NameMiddle NameLast Name
- Dependent DOB:*
  
  MonthDayYear
  Date
- Dependent Relationship: *
- Document Upload:*
  
  Dependent 1 Document Upload: SS card
  Cancelof
- Dependent Full Name: *
  
  First NameMiddle NameLast Name
- Dependent DOB: *
  
  MonthDayYear
  Date
- Dependent Relationship: *
- Document Upload: *
  
  Dependent 2 Document Upload: SS card
  Cancelof
- Dependent Full Name: *
  
  First NameMiddle NameLast Name
- Dependent DOB: *
  
  MonthDayYear
  Date
- Dependent Relationship: *
- Document Upload: *
  
  Dependent 3 Document Upload: SS card
  Cancelof
- Dependent Full Name: *
  
  First NameMiddle NameLast Name
- Dependent DOB: *
  
  MonthDayYear
  Date
- Dependent Relationship: *
- Document Upload: *
  
  Dependent 4 Document Upload: SS card
  Cancelof
- Dependent Full Name: *
  
  First NameMiddle NameLast Name
- Dependent DOB: *
  
  MonthDayYear
  Date
- Dependent Relationship: *
- Document Upload: *
  
  Dependent 5 Document Upload: SS card
  Cancelof
- YesNo
- List of Employers:
  Please List the names of all companies worked:
- Document Upload:
  
  Upload (W-2s)
  Cancelof
- YesNo
- Document Upload:
  
  Upload Business Documents (1099s, Profit/Loss, EIN Letter, etc.)
  Cancelof
- I certify that I am the authorized owner/representative of the business related to the documents uploaded. I confirm that I have maintained adequate records, including receipts, invoices, and logbooks, to support the income and expenses claimed for this tax year. I understand that the IRS requires me to retain these records for a minimum of 3 years to prove deduction eligibility.
  
  Business Documentation: I confirm that I have uploaded all relevant financial records, including Gross Receipts, Business Expenses, and mileage logs, and that these documents represent the complete financial activity of my business for the tax year.
  
  Preparer Reliance & Circular 230 Disclosure: > I confirm that Pro Tax Genie has relied on the information and documents provided by me above to prepare my Schedule C in accordance with IRS Circular 230 and federal tax laws. I understand that the preparer has not audited my specific receipts or logs. I declare under penalty of perjury that the information provided is true, correct, and complete to the best of my knowledge.
- Business Owner Certification*
  
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- I certify that all information and uploaded documents regarding my income, business, and expenses are true, correct, and complete. I am responsible for the accuracy of my tax return.
  
  Dependents: I confirm that all listed dependents lived with me for more than half of the year and I provided over half of their support. I possess all verifiable records to support these claims as required by the IRS.
  
  Records: I confirm I have maintained all necessary receipts, invoices, and logs as required by law for a minimum of 3 years.
  
  Authorization: Under penalty of perjury, I authorize Pro Tax Genie to prepare my 2025 tax returns based on the data provided.
- Date Signed:*
  
  MonthDayYear
  Date
- Taxpayer Signature of Acceptance*
  
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