Tax Intake Form

Tax Intake Form
Full Name*

First NameLast Name
Spouse Full Name (If Filing Joint)

First NameLast Name
Date of Birth*

MonthDayYear
Date
Spouse Date of Birth

MonthDayYear
Date
Social Security Number*
Spouse Social Security Number
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Occupation*
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Dependent Name
Dependent Social Security Number
Dependent Date of Birth

MonthDayYear
Date
Relationship
Dependent Name
Dependent Social Security Number
Dependent Date of Birth

MonthDayYear
Date
Relationship
Dependent Name
Dependent Social Security Number
Dependent Date of Birth

MonthDayYear
Date
Relationship
SingleMarried Filing JointlyMarried Filing SeparatelyHead of HouseholdQualifying Widow(er)
Did you file a return last year?*
Audited by the IRS?*
Did you have Marketplace Insurance?*
Did you receive unemployment last year?
Direct Deposit- Routing Number
Direct Deposit- Account Number
Referred By?
Did you file taxes last year?*
Do you have access to your IRS.GOV account?*
What was your AGI from last year?
YesNo
Upload Your ID/Drivers License*

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Upload Your Social Security Cards*

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Upload Your Tax Documents (e.g., W-2, 1099, previous tax return, etc.)

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JFA CAPITAL GROUP will provide professional tax consulting services for your individual tax return based on the information you furnish to us. Our role is to advise, strategize, and guide you through the tax process; however, you, the taxpayer, remain ultimately responsible for the accuracy, preparation, and filing of your tax return.

I, the Taxpayer named above, acknowledge that I have provided JFA CAPITAL GROUP with the attached tax information and, to the best of my knowledge, this information is true, correct, and complete.
Taxpayer Signature*
Spouse Signature
Date*

MonthDayYear
Date
Additional Information or Notes
Should be Empty: