2026-2027 Client Tax Preparation Intake Form

2026-2027 Client Tax Preparation Intake Form

Intake form for Ultimate Tax Services LLC in Raeford, NC. Please complete all sections and review the consent statements before signing.
Ultimate Tax Services LLC
Client Info
Full Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Tax ID Number
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Filing Status
Occupation
Employer
Returning Client
Spouse and Dependents
Spouse Name

First NameMiddle NameLast Name
Spouse Date of Birth

MonthDayYear
Date
Spouse Tax ID
Spouse Occupation
Number of Dependents
Dependent Details
Income
Did you receive any W-2 income?
Number of W-2 forms
Did you have self-employment income reported on 1099 forms?
Business type
Gross income estimate
Did you receive unemployment income?
Did you receive Social Security income?
Did you receive retirement income?
Did you receive interest or dividend income?
Other income
Deductions
Mortgage Interest
Mortgage Interest Amount
Student Loans
Student Loan Amount
Charitable Donations
Childcare Provider Name

First NameMiddle NameLast Name
Childcare Amount
Marketplace Insurance
IRA Contributions
Education Expenses
Earned Income Credit Eligibility
Bank Info
Refund Method
Bank Name
Routing Number
Account Number
Account Type
Authorize Fee Deduction
Legal Consent
CONSENT TO USE AND DISCLOSURE OF TAX RETURN INFORMATION - Pursuant to Internal Revenue Code Section 7216 and Treasury Regulation 301.7216-3, I hereby consent to the use and disclosure of my tax return information by Ultimate Tax Services LLC for the purpose of preparing my 2026 federal and state income tax returns. I understand that my tax return information will not be disclosed or used for any purpose other than the preparation and filing of my tax returns without my express written consent. This consent is valid for one year from the date of signature.
I consent to the use and disclosure of my tax information as described above
ENGAGEMENT AGREEMENT - I engage Ultimate Tax Services LLC to prepare my 2026 federal and applicable state income tax returns. I understand that I am responsible for providing accurate and complete information. I acknowledge that Ultimate Tax Services LLC relies on the information I provide and is not responsible for errors resulting from incomplete or inaccurate information furnished by me. I agree to pay all preparation fees as disclosed prior to filing.
I agree to the engagement terms described above
PAYMENT RESPONSIBILITY - I understand that if my refund is reduced, offset, or intercepted by any federal or state agency, I remain responsible for all tax preparation fees incurred. I agree to pay any outstanding balance within 30 days of notification.
I accept responsibility for all fees and charges described above
Signature
Ultimate Tax Services LLC | Raeford, NC | All information provided is protected under IRS regulations and our Written Information Security Plan (WISP).
Date

MonthDayYear
Date
Should be Empty:

2026-2027 Client Tax Preparation Intake Form

Ultimate Tax Services LLC

Client Info

Spouse and Dependents

Income

Deductions

Bank Info

Legal Consent