CLIENT INTAKE FORM

CLIENT INTAKE FORM

PLEASE SUBMIT FORMS THAT ARE READABLE / LEGIBLE
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
BANK NAME, ROUTING AND ACCOUNT NUMBER FOR DIRECT DEPOSIT
DOUBLE CHECK INFORMATION.
DRIVER'S LICENSE, ID, OR PASSPORT

MAKE SURE IT'S A GOOD STRAIGHT CLEAR PICTURE.
Cancelof
SOCIAL SECURITY CARD

MAKE SURE IT'S A GOOD STRAIGHT CLEAR PICTURE.
Cancelof
W2, 1099, OR SELF EMPLOYED DOCUMENTS

MAKE SURE IT'S A GOOD STRAIGHT CLEAR PICTURE.
Cancelof
DEPENDANT_1 SOCIAL SECURITY CARD, BIRTH CERTIFICATE, MEDICAL RECORD.

MAKE SURE IT'S A GOOD STRAIGHT CLEAR PICTURE.
Cancelof
DEPENDANT_2 SOCIAL SECURITY CARD, BIRTH CERTIFICATE, MEDICAL RECORD.

MAKE SURE IT'S A GOOD STRAIGHT CLEAR PICTURE.
Cancelof
MORTGAGE 1098_T

MAKE SURE IT'S A GOOD STRAIGHT CLEAR PICTURE.
Cancelof
HEALTH INSURANCE DOCUMENTS

MAKE SURE IT'S A GOOD STRAIGHT CLEAR PICTURE.
Cancelof
ADDITIONAL DOCUMENTS

MAKE SURE IT'S A GOOD STRAIGHT CLEAR PICTURE.
Cancelof
DID THE DEPENDANT/S LIVE WITH YOU THE ENTIRE YEAR?

YESNOI DON’T HAVE DEPENDANTS
ANYONE ELSE CLAIMING DEPENDANT/S?

YESNOI DON’T HAVE DEPENDANTS
DO YOU WANT THE CASH ADVANCE $500 - $7000.00?

YESNO
DO YOU HAVE MARKETPLACE INSURANCE?

YESNOHEALTH INSURANCE FROM MY JOB.I'M NOT SURE
DID YOU RECEIVE A 1095_A FORM FOR HEALTH INSURANCE?

YESNONOT YETI'M NOT SURE
DID YOU WIN MONEY GAMBLING, LOTTERY, CRYPTO, FORX, STOCKS OR SALE OF PROPERTY/IES

YESNO
DO YOU OWE THE IRS?

YESNONOT SURE
EXPECTED RETURN?
WHAT WAS THE REFUND AMOUNT LAST YEAR
ANY QUESTIONS OR INFORMATION YOU WANT TO SHARE?
PLEASE PROOF READ BEFORE SUBMITTING.
Do you know anyone who owes on taxes every year?
Who referred you?
$1000 when you refer 10 people. Each person referred is $100. Go through your phone and find 10 potential people. Simply forward them the link to this client intake form.
Signature
Should be Empty: