Client Intake Form for 2025

Client Intake Form
What year are you filing?*
How did you hear about us?

Social MediaReferralPrevious ClientWebsite
Client Type*

Returning ClientNew Client
Do you plan on purchasing a home in the next 2 years?*

YesNo
Do you need CREDIT REPAIR?*

YesNo
Taxpayer Information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
What COUNTY do you live in?*
What is the name of your school district?*
Use google if you're unsure
Email Address*
example@example.com
Phone Number*

Area CodePhone Number
Occupation*
Does any of the following apply?*

DeceasedBlindCan Be Claimed As A DependentNone of these apply
Taxpayer's SSN*
What is your marital status as of December 31st, 2025?
Date of Birth*

MonthDayYear
Date
Date of Death

MonthDayYear
Date
Drivers License/ ID*

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Upload social security cards and birth certificates for you and all dependents

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Upload a utility bill

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Upload a lease

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Upload your last years tax return if accessible

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Please upload IP PIN

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SPOUSE INFORMATION
Spouse Name

First NameLast Name
Spouse SSN
Spouse Phone Number

Area CodePhone Number
Spouse Email Address
example@example.com
Spouse Date of Birth
Spouse Drivers License/ID/SSC/BC

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Questionnaire

*Answering these questions will toggle specific forms for your tax situation to keep you from answering irrelevant information and to save time and give you a more accurate quote*
Do you currently have dependents?*
If so, how many dependents do you have?
Are you filing a business/selfemployed/side job/cash job?*

YesNo
Did you or your family have health insurance at any time in 2025 from the MARKETPLACE? HEALTHCARE.GOV*

YesNo
Do you owe student loans, taxes, or any other entity that might offset your refund?*

YesNo
INCOME
Please select each type of income that you received for the 2025 year.

W2Unemployment Income (1099G)Self Employment (1099NE/1099K/1099MISC)Household Income (Home Health/Nanny)1098T FilerInterest IncomeAlimonyNo IncomeOther
Did you work OVERTIME?

YesNo
If you worked overtime, upload your last checkstub

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Upload all income documents for 2025!

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DEDUCTIONS & CREDITS
Which of the following applies to you?

I paid a daycare or a nanny to care for my child 13 years or younger while I worked or looked for work. I can get a statement with their EIN/SSN to provide this claimI attended a college/university/community college/post-secondary institution/career school and paid eligible expenses that can be proven with a 1098T formI paid charity/tithes/or given donations to community organizaions and/or religious institutionsI paid a over $12,400 in expenses for itemizationI paid student loan interest and received a 1098EI had eligible medical expensesI had energy and solar power expensesI sold and/or purchased a homeI adopted a child or had a babyI am in the military and had to moveI got sepearated/divorced paid or received alimony
Out-of-Pocket Expenses

Insurance premiums you paid (medical, dental, vision)Amount paid to providers (doctors, dentists, etc.) PrescriptionsX-rays, lab work, etc.Nursing services (in-home or at a care facility)Hospital care (including meals and lodging)Alcohol and drug rehabilitationMedical aids (hearing aids, crutches, wheelchairs, etc.)
DEPENDENT INFORMATION
Dependent Name

First NameLast Name
Dependent Date of Birth

MonthDayYear
Date
Dependent SSN
What is Dependent #1's relationship to you (son, daughter, etc.)?
How many months did Dependent #1 live with you in 2025? (If all year, enter 12)
Dependent #2 Name

First NameLast Name
Dependent #2 Date of Birth

MonthDayYear
Date
Dependent #2 SSN
What is Dependent #2's relationship to you (son, daughter, etc.)?
How many months did Dependent #2 live with you in 2025? (If all year, enter 12)
Dependent #3 Name

First NameLast Name
Dependent #3 Date of Birth

MonthDayYear
Date
Dependent #3 SSN
What is Dependent #3's relationship to you (son, daughter, etc.)?
How many months did Dependent #3 live with you in 2025? (If all year, enter 12)
Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.

YesNo
Upload a copy of your daycare form here

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REFUND SELECTION
Name of bank
Routing #
Account #
How would you like your refund?*

Paper check printed in officePrepaid debit cardDirect deposit
What type of bank account do you have?*

CheckingSavings
DUE DILIGENCE QUESTIONNAIRE
If you will be claiming an Earned Income Credit, Child Tax Credit, Additional Child Tax Credit, HOH, and/ or an American Opportunity Credit on your 2025 tax return, you must complete this questionnaire.

The United States Congress have, as a reaction to the substantial tax fraud resulting from their original error of choosing to distribute federal social welfare program benefits via the tax return, placed new excessive inappropriate "due diligence" requirement on paid tax return preparers whose client are claiming certain tax credits. This added to the excessive and inappropriate requirements previously implemented by the Internal Revenue Service, the IRS has forced tax preparers to question and verify that their clients qualify to receive certain credits i.e. EIC, CTC, ACTC, and now HOH.
I am the custodial parent for the dependent(s) for whom the tax credit(s) will be requested, and I released the dependency deduction to my former spouse for 2025 by signing Form 8332 (release / Revocation of claim to exemption for Child by Custodial Parent).*

YesNo
I certify that the child(ren) for whom the tax credit(s) will be requested can be claimed as my dependent(s), as per the information provided at the end this questionnaire.*

YesNo
I or my child(ren) , have documentation to substantiate the credit(s) being claimed , such as form 1098-T , bills, statements, and receipts for college tuition,fees, books, and material cost (you are responsible for keeping this documentation and providing it to the IRS if you are audited or questioned).*

YesNo
The child(ren) for whom the tax credit(s) will be requested has lived with me for the entire year of 2025. *

YesNo
Was a child Tax Credit, Additional Child Tax Credit, or American Opportunity Credit claimed by you disallowed or reduced by the IRS on a past tax return?*

YesNo
I am unmarried or separated, support a qualifying person as your dependent, and pay more than half the cost of maintaining your household.*

YesNo
Are you on Section 8?*

YesNo
Do you receive government assistance?*

YesNo
Does your yearly income exceed $17k/ year?*

YesNo
Do you pay for 50% or more for the upkeep of your home?*

YesNo
Are you claiming your own dependents?*

YesNo
If you selected No, please provide the reason you are claiming someone else's dependent.
Do you understand that if you are not claiming your own dependent that you will need a Notarized document from the parents/ guardian that you have permission to claim the child and why.

YesNo
Notarized document from dependents parent/guardian

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ATTENTION AND DISCLAIMER
I AGREE, The information contained in this office or on this website is of a general nature. It should not be construed as legal advice nor should it be acted upon in your specific situation without further details and/or professional assistance. Any use of information contained in this office or on our web site is done so at the risk of the user, and Executive Consulting & Tax Group is not responsible for the result or outcome of its use. Executive Consulting & Tax Group does not guarantee and is not liable for the truthfulness, accuracy, effectiveness, or any resulting effects of the use of any information contained in this office or on the web site. It is advised and it is the responsibility of the visitor of this office or web site to seek proper instruction and/or seek professional assistance in all matters regarding taxes and the IRS. Executive Consulting & Tax Group is thus held harmless, released of, and users of information contained in this office or on this web site assume full responsibility for, any violation of Tax laws and/or IRS procedure, and any other legal liability resulting from use of any information contained in this office or on this web site. I attest that all information contained in this income tax return was obtained from the taxpayer or spouse and is true and correct to the best of his/her knowledge.*

YesNo
I, "Tax Client", give and express full written and verbal permission over to "Executive Consulting & Tax Group" and it's employees/agents/representatives to contact the American Offset Debt Line/Treasury Offset Program on behalf of myself to determine if I have any non-tax debt that could potentially offset my current tax return. The Offset Debt Line contact number is 1-800-304-3107.*

YesNo
I understand as the taxpayer that Executive Consulting & Tax Group is not responsible if my tax refund is offset by the IRS, student loans or Child support and any other government agency or if the check is mailed or direct deposit into my account with the prep fees. I will still have to pay the company the fees associated with filing my tax return. I understand that I have 30 days to make payment and if this payment isn't made legal actions will be sought for payment resolution.*

YesNo
I agree by signing my name that I have answered the above due diligence questionnaire and give consent to use of my information to file my tax return and that all information given is correct to the best of my knowledge. Executive Consulting & Tax Group is not responsible if the taxpayer provides us with incorrect information (i.e social security numbers, names, or date of births) and I understand this will delay my refund. Executive Consulting & Tax Group is not responsible for IRS Tax Audits and all information obtained must be presentable if the IRS audits your tax return. You must pay $75 for Audit assistance separately if you need to utilize this service. Executive Consulting & Tax Group provides each customer one complimentary copy of their return. Should you need additional copies, there is a $15 fee per copy. We are not responsible for any changes by the IRS or Bank on disbursement dates, filing status, or any other required information from the IRS. We Do Not Reimburse any bank fees in the event of delays out of our control.
Signature*

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Client Intake Form

Taxpayer Information

SPOUSE INFORMATION

Questionnaire

INCOME

DEDUCTIONS & CREDITS

DEPENDENT INFORMATION

REFUND SELECTION

DUE DILIGENCE QUESTIONNAIRE

If you will be claiming an Earned Income Credit, Child Tax Credit, Additional Child Tax Credit, HOH, and/ or an American Opportunity Credit on your 2025 tax return, you must complete this questionnaire.

ATTENTION AND DISCLAIMER