CB Tax LLC Client Intake Form

Client Intake Form

Please have a copy of your ID and the tax documents you would like to upload ready.
Tax Year
Client Type
REFERRAL SECTION

Referral must be listed at time of submission to qualify!
Were you referred to CB Tax LLC?
Referral Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
TAXPAYER INFORMATION
Taxpayer Name

First and Middle NameLast Name
Taxpayer SSN
Taxpayer Date of Birth
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Do you(TAXPAYER) have an IRS IP PIN?
Enter IP PIN
Are You Married?
Are You Filing With A Spouse?
SPOUSE INFORMATION
Spouse Name

First and Middle NameLast Name
Spouse SSN
Spouse Date of Birth
Spouse Phone Number
Spouse Email
Do SPOUSE have an IRS IP PIN?(If Yes, Please enter below)
Address (Current Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are You Filing Dependents?
If yes, please make sure every question is answered for every dependent! Social Security Card Required
DEPENDENT INFORMATION

Please list only dependents who lived with you for over six months in the tax year, excluding yourself and your spouse. SOCIAL SECUIRTY CARD IS REQUIRED
Dependent 1

First and Middle NameLast Name
Dependent SSN
Dependent Date of Birth
Select Relationship To You
Do dependent have an IRS IP PIN?(If Yes, Please enter below)
Did Your Dependent Live With You More Than Half The Year?
Dependent 2

First and Middle NameLast Name
Dependent SSN
Dependent Date of Birth
Select Relationship To You
Do dependent have an IRS IP PIN?(If Yes, Please enter below)
Did Your Dependent Live With You More Than Half The Year?
Dependent 3

First NameLast Name
Dependent SSN
Dependent Date of Birth
Select Relationship To You
Do dependent have an IRS IP PIN?(If Yes, Please enter below)
Did Your Dependent Live With You More Than Half The Year?
Dependent 4

First and Middle NameLast Name
Dependent SSN
Dependent Date of Birth
Select Relationship To You
Do dependent have an IRS IP PIN?(If Yes, Please enter below)
Did Your Dependent Live With You More Than Half The Year?
Should you have more than four dependents, please include their details in the ADDITIONAL INFORMATION SECTION.
DIRECT DEPOSIT INFORMATION

PLEASE PUT BANK ACCOUNT AND ROUTING NUMBER IN TWICE TO MAKE SURE WE HAVE THE CORRECT NUMBERS
Routing Number
Account Number
Verify Routing Number
Verify Account Number
Type of Account
Are you claiming dependents
SWORN STATEMENT OF RESIDENCY

Fill Out Form If You Are Claiming Dependents
Name of Parent(s) or Guardian(s)

First NameLast Name
Dates the dependent(s) lived with you in the tax year
Ex: (Jan 1 to Dec 31, 2025)
Address that your dependent (s) lived with you at for more than 6 months in the tax year

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
List All Dependents That Lived With You From Your Tax Return
Dependent 1
Dependent 2
Dependent 3
Dependent 4
In the event of an IRS audit I can provide the following documents to prove the dependent residency.

Other
If you selected other above list document
Print Name

First NameLast Name
Signature
Date

MonthDayYear
Date
Engagement Letter
Dear Client,

Thank you for choosing our firm for your income tax preparation needs. This engagement letter outlines the terms and conditions of our services and your responsibilities as our client. Please read carefully, as your signature indicates agreement with the terms stated below.

Scope of Services
We will prepare your 2025 federal and state individual income tax returns based on the information you provide. This agreement represents our mutual understanding of the services to be rendered. Any additional services outside of individual tax preparation will require a separate engagement letter and fee arrangement.

Client Responsibilities
You agree to provide accurate, complete, and timely information necessary for the preparation of your tax returns, including but not limited to income statements, expense records, deductions, dependents, and credits. We will not audit or independently verify the information provided. We may ask clarifying questions to ensure compliance and accuracy.

If information is provided verbally, your signature below will confirm that it is true and correct to the best of your knowledge.

Tax Credits and Filing Status
If you are claiming any tax credits—such as the Earned Income Credit, Child Tax Credit, Additional Child Tax Credit, Education Credits—or filing Head of Household, you certify that you meet all requirements and have supporting documentation if requested by the IRS or state agencies.

Documentation & Recordkeeping
You are responsible for maintaining all original documentation, including receipts and proof required by tax authorities. Our office may retain copies of certain documents for our records, after which they may be securely destroyed. We will return all original documents to you.

Legal and Financial Responsibility

You are legally responsible for the information provided on your tax return. Providing false or incomplete information can result in penalties, interest, and legal consequences. We are only responsible for errors that are a direct result of our preparation.

Audit and Examination

Tax returns may be selected for review or audit by the IRS or state authorities. You may be required to present supporting documents. Audit representation is not included in your tax preparation fee and requires a separate agreement.

Completion and Fees

Upon completion of your tax return, all applicable preparation fees become due immediately unless payment is being made through an approved refund transfer product. You will receive a copy of your return once payment has been satisfied. You agree to review your return promptly and notify our office of any concerns or inaccuracies.

Fees are determined based on the complexity of your return, the forms and schedules required, and the time and expertise necessary to complete your filing. Our fees are not contingent upon the amount of your refund, the outcome of your return, or any tax credits claimed.

Cancellation After Return Completion

If your return has been completed and you choose not to proceed with filing or decide you no longer want our services, a non‑refundable fee of $150 will be charged to cover the time, labor, and resources used to prepare your return. This fee applies even if the return is not filed.

Payment Authorization and Outstanding

Balances By signing this agreement, you authorize our firm to charge any unpaid balance for services to the payment method(s) you have provided and that are kept on file for the purpose of unpaid service. Any remaining balance not paid at the time of service may be automatically debited without additional notice.

If a refund transfer is used and your refund is delayed, reduced, offset, or denied by the IRS or state agency, you remain fully responsible for the full preparation fee. Any unpaid balance will be charged to the payment method(s) on file.

Late Payments and Returned Transactions

If a payment method is declined, returned, or otherwise unsuccessful, you agree to provide an alternative payment method within 24 hours. Accounts with unpaid balances may incur late fees, collection costs, or suspension of future services until the balance is resolved.

Communication and Email Notice
We may communicate with you via email or SMS. While we take precautions, electronic communication may not be fully secure. We are not responsible for unauthorized access to communications outside of our control.

Confidentiality and Data Protection
Your information will remain confidential and will not be disclosed without your consent unless required by law. By signing this letter, you agree that we may use your contact information for internal purposes such as appointment reminders, service updates, or general communications. You may opt out of marketing emails or SMS at any time.

IRS Authorization
By signing this document, you authorize our firm to discuss aspects of your return with the IRS for up to one year following the return’s due date.
Signature
Date

MonthDayYear
Date
NOTES (Any additional information we need to know)
Please upload any tax documents needed to prepare this tax return

(Valid Picture ID, Copy of Social Security Cards, W2s, 1099s, Healthcare Forms, Proof of Residency, Any Forms that need to go with file etc.)
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Please upload valid Driving License or Identification

(Valid Picture ID, Copy of Social Security Cards, W2s, 1099s, Healthcare Forms, Proof of Residency, Any Forms that need to go with file etc.)
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Should be Empty:

Client Intake Form

REFERRAL SECTION

TAXPAYER INFORMATION

SPOUSE INFORMATION

DEPENDENT INFORMATION

DIRECT DEPOSIT INFORMATION

SWORN STATEMENT OF RESIDENCY

List All Dependents That Lived With You From Your Tax Return

Engagement Letter