FLS Tax Client Intake Form 2025

Complete this intake form to file your taxes today!
How did you hear about us? Please select an option below.
What tax year is this submission for? (Please ensure that only documents for the selected tax year are attached. If you need multiple years filed, each year must be submitted as a separate request with its corresponding documents.) *
2. Name:

First NameMiddle NameLast Name
3. Email:
example@example.com
4. Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
5. Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
6. County
7. Birthdate:

MonthDayYear
Date
8. Social Security Number:
9. Occupation Title:
10. Spouse Full Name:

First NameLast Name
11. Spouse Email:
example@example.com
12. Spouse Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
13. Spouse Occupation:
19. Are you disabled?
20. Select your filing status:
28. If you are filing head of Houshold, what documents will you provide for proof of head of household?
21. Were you audited by the IRS last year?
22. Did you purchase a vehicle recently?
If yes, please list the year make and model of the vehicle.
23. Do you have any credits that were disallowed or reduced?
24. If you have any credits that were disallowed or reduced, please enter here.
Identity Protection Pin

To ensure a smooth and efficient process, all clients must verify that they do or do not have an IP PIN. We cannot proceed without proof of validation. Please follow the steps below to check your status.
25. Do you have an IP PIN?
26. What is your 2024 Identity Protection Pin & who it was issued to. (If applicable)
Steps to Verify Your IP PIN Status:
1. Visit the IRS website: www.irs.gov
2. Sign in to your account. If you do not have an account, please create one.
3. Once logged in, navigate to the menu option in the top right-hand corner.
4. In the menu drop-down, select “Profile” from the list of options.
5. Scroll down to the "Identity Protection PIN" section.
6. Take a screenshot of your Identity Protection PIN section.
7. • If your profile states to ENROLL for PIN, please proceed to Step 8.
  • If your profile states that you DO have a PIN and you ARE ABLE to retrieve it, please proceed to Step 8, and Step 9.
  • If your profile states that you DO have a pin but you are unable to retrieve it, exit this form, and inform your tax preparer of your IP PIN status.
8. Please provide us with a screenshot similar to the one below. (Please note that your screenshot may be different due to the status of your IP Pin)
Please Upload Your IP PIN Status Screenshot.

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8. If you have a PIN that was retrievable, please provide it below.
1095 A
27. Did you receive marketplace health insurance??
28. Upload 1095 A form here, if applicable:

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Dependency
29. Dependent 1: (Name, Social Security #, Date of Birth, Relationship to Taxpayer).
30. Dependent 2: (Name, Social Security #, Date of Birth, Relationship to Taxpayer).
31. Dependent 3: (Name, Social Security #, Date of Birth, Relationship to Taxpayer).
32. Dependent 4: (Name, Social Security #, Date of Birth, Relationship to Taxpayer).
33. If any of your dependents are disabled list them here:
34. What document will you provide for proof of residency for child dependents?

Other
35. Please upload proof of residency for each dependency.

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Please answers only if it applies to you.
36. If your address is different than the one thats on your government ID or drivers license, please indicate the reason why
37. If applicable, please indicate why you are claiming a dependent that is not related to you. What are the circumstances that you have supported this dependent for at least 6 months of 2025. Please outline the support you have provided to this dependent.
38. Are all of the dependents being claimed related to the taxpayer by birth or bloodline? If not, please identify which child is not related to you?
39. Please answer if applicable, if your last name is different than your dependent's last names, that you are filing, what is the reason why? Please indicate the reason why there is a difference in the last names between you and your dependents.
40. Please answer, only if applicable: If your income is at or below $13,000.00 & you have 2 or more children, how are you able to maintain the household. For example, did you receive government assistance, as such as: section 8, public housing, SNAP benefits, or other.
41. If you are the father of the child and claiming the child. Please indicate the reason why the child is living with you and not the mother. Please outline the support you have provided to the child.
Self Employment
42. Did you have a business in 2025? Includes 1099s, or side business. Ex. hair braiding, hair stylist, baby sitting, uber, lyft, door dashing, & etc. If so, what is the name & nature of your business or side business. If you don't have a name, you can bypass the name.
43.Do you need assistance with organizing your/side hustle business income & expenses?
44. Self Employed/ Side Hustle Income Documents/Statements:

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Upload Personal Documents
45. Please upload your drivers license/ID for you & your spouse (if applicable)

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46. Social Security Cards for Each Individual OnTax Return

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47. Please upload proof of head of household, if applicable.

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Federal Financial Documents
48. Financial Tax Documents (W2,1099,Unemployment,ect)

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49. If you received a 1099G form for unemployment, please upload it here.

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50. If you received a 1098T form for school, please upload here.

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Other Documents

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51. Do you want to apply for cash advance up to $7k. No credit check. You will be notified if you are approved within 24 hours.
52. How do you want to receive your refund?
If you selected direct deposit, please enter your information below
Bank Name
Account Number
Confirm Account Number
Routing Number
Confirm Routing Number
Tax Form Abandonment/Ach Agreement

Here at Fully Lowe'd Services. Unfulfilled Tax Quotes will result in a $150 Service Fee - If the client decides to file their tax return elsewhere. This fee will be processed through our payment merchant until fulfilled. If the client files their taxes with us, they will be charged the regular tax filing fees processed from the tax return per usual. No upfront fees - all fees will be cured from the tax return unless otherwise agreed due to intricate tax situations. Thank you - Fully Lowe'd Services LLC
Fully Lowe'd Services, LLC

will prepare your 2025 individual tax return from the information you furnished to us. You, the taxpayer, are ultimately responsible for the preparation and filing of your tax return. I, the Taxpayer named above, have provided to Fully Lowe'd Services, LLC the attached tax information and to the best of my knowledge this information is true, correct, and complete.
Tax Payer Signature ( Must be legible)
Spouse Signature
Notes (anything you think we need to know :)
Should be Empty:

Complete this intake form to file your taxes today!

Identity Protection Pin

1095 A

Dependency

Please answers only if it applies to you.

Self Employment

Upload Personal Documents

Federal Financial Documents

If you selected direct deposit, please enter your information below

Tax Form Abandonment/Ach Agreement

Fully Lowe'd Services, LLC