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CLIENT INTAKE FORM
PLEASE SUBMIT FORMS THAT ARE READABLE / LEGIBLE
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / 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
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SOCIAL SECURITY CARD
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W2, 1099, OR SELF EMPLOYED DOCUMENTS
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DEPENDANT_1 SOCIAL SECURITY CARD, BIRTH CERTIFICATE, MEDICAL RECORD.
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DEPENDANT_2 SOCIAL SECURITY CARD, BIRTH CERTIFICATE, MEDICAL RECORD.
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MORTGAGE 1098_T
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HEALTH INSURANCE DOCUMENTS
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ADDITIONAL DOCUMENTS
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DID THE DEPENDANT/S LIVE WITH YOU THE ENTIRE YEAR?
YES
NO
I DON’T HAVE DEPENDANTS
ANYONE ELSE CLAIMING DEPENDANT/S?
YES
NO
I DON’T HAVE DEPENDANTS
DO YOU WANT THE CASH ADVANCE $500 - $7000.00?
YES
NO
DO YOU HAVE MARKETPLACE INSURANCE?
YES
NO
HEALTH INSURANCE FROM MY JOB.
I'M NOT SURE
DID YOU RECEIVE A 1095_A FORM FOR HEALTH INSURANCE?
YES
NO
NOT YET
I'M NOT SURE
DID YOU WIN MONEY GAMBLING, LOTTERY, CRYPTO, FORX, STOCKS OR SALE OF PROPERTY/IES
YES
NO
DO YOU OWE THE IRS?
YES
NO
NOT 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.
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