QBPage_Tax Prep Intake Form - Returning Clients

QBPage_Tax Prep Intake Form - Returning Clients

Returning Tax Client Intake Form

Name

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Has your family information changed since last year (spouse or dependents)?
If your family's information has changed since last year, provide a brief description:

Did you, your spouse, and your dependents all have health insurance for all 12 months last year? If yes, who covers it?

Rows	Yes/No	Employer	Spouse Ins	Exchange/ Marketplace	Direct with Insurer	Medicare	Medicaid
Taxpayer
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Please enter any relevant expenses for this tax reporting year only:

Rows	Amount
Charitable Contributions
Medical Expenses (paid out of pocket)
Losses due to theft, fire, or natural disaster
Accounting or Tax Preparation Fees
Legal Fees
Investment Expenses

Additional comments or things you wish to discuss with the tax preparer:
Which bank account should be used to direct deposit the refund and deduct fees:
Please upload tax docs here (these can include, but are not limited to, forms W2, 1099, 1098-T, HSA 8889, Mortgage Interest, Contribution Statements):

Cancelof

By signing below, you acknowledge that:
- All information entered here is accurate and true
- You understand your responsibilities as the tax client
- Understand our responsibilities as the tax preparer, including that information submitted to us will be accepted as true and accurate as entered and used to prepare a return
- You allow the Tax Preparer or their authorized staff to capture sensitive data necessary to prepare and file returns
- Agree to pay the tax preparation fee for the review and preparation of the tax return, regardless of outcome of tax owed or due by refund, unless tax preparer is notified that an alternate payment method should be used
Date Signed

MonthDayYear
Date
Taxpayer Signature
Date Signed

MonthDayYear
Date
Spouse Signature (if applicable)
Should be Empty: