Diverse Tax Gem 💎 – Business Tax Services Intake Form
Share your business and tax details, return status, income/expenses, and upload key documents securely for tax preparation.
Business & Contact Information
Business legal name
*
DBA / trade name
Entity type
*
Please Select
Sole Proprietorship
Partnership
LLC
Corporation
S Corporation
Nonprofit
Trust
Estate
Other
Business start date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Tax year
*
Please Select
Calendar year
Fiscal year
Other
Accounting method
Cash
Accrual
Other / Unknown
State of formation
States where business operates
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other
Owner / contact legal name
*
First Name
Middle Name
Last Name
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email address
*
example@example.com
Mailing address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Business address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Ownership / Entity Details
Business entity type
*
Please Select
Sole proprietorship
LLC
Partnership
S corporation
C corporation
Other
Owners / partners / shareholders
*
Does the business have multiple owners?
*
Yes
No
Additional ownership or entity details
Return History & Notices
Type of Return
*
First-year return
Final return
Amended return
Regular return
Prior-Year Return Available?
*
Yes
No
Not sure
Prior Preparer Name or Firm
Extensions Filed
Federal
State
Both
None
Not sure
Estimated Tax Payments Made
Federal
State
Both
None
Not sure
Notices Received
IRS notice
State notice
Local notice
None
Not sure
Unfiled Tax Years and Details
Changes in Ownership, Entity, or Business Address
Income
Gross receipts / sales
*
Amount received by cash
Amount received by check
Amount received by card or app payments
Forms received
1099-NEC
1099-MISC
1099-K
Interest statements
Other income forms
None
Refunds, returns, and allowances
Available records
*
Bookkeeping records
Profit and loss statement
Bank statements
Sales reports
None
Other business income details
Expenses
Which expense categories do you have to report?
*
Advertising/Marketing
Commissions & Fees
Contract Labor
Wages/Payroll
Employee Benefits
Insurance
Interest
Legal/Professional Fees
Office Expenses
Rent/Lease
Repairs/Maintenance
Supplies
Taxes/Licenses
Travel
Meals
Utilities
Phone/Internet (Business Portion)
Software/Subscriptions
Bank/Merchant Fees
Education
Shipping/Postage
Other
Advertising / Marketing expenses
Commissions and fees
Contract labor paid
Wages and payroll expenses
Employee benefits
Insurance expenses
Interest expense
Legal and professional fees
Office expenses
Rent or lease expense
Repairs and maintenance
Supplies
Taxes and licenses
Travel expenses
Deductible meals
Utilities
Business phone and internet portion
Software and subscriptions
Bank and merchant fees
Education and training
Shipping and postage
Other expenses
Vehicle Use
Vehicle placed in service date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Business miles driven
*
Personal miles driven
Total miles driven
*
Mileage log available?
*
Yes
No
Vehicle-related expenses
Parking
Tolls
Fuel
Oil changes
Repairs & maintenance
Insurance
Lease payments
Registration & fees
Depreciation/actual expenses
Other
Home Office
Is the home office used exclusively and regularly for business?
*
Yes
No
Office square footage
*
Total home square footage
*
Rent or mortgage interest
Utilities
Home insurance
Other related home-office expenses
Assets / Equipment
Asset / Equipment Details
*
Asset Type
*
Please Select
Computer/Office Electronics
Furniture/Fixtures
Machinery/Tools
Vehicle
Equipment
Building
Land
Other
Asset Description
*
Transaction Type
*
Purchased
Sold
Date Acquired or Sold
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Cost or Proceeds
*
Business Use Percentage
Additional Notes
Employees & Contractors
Do you have any W-2 employees?
*
Yes
No
Payroll provider name
Which payroll tax filings do you handle?
Form 941
Form 940
State payroll returns
Local payroll returns
Other
Have you issued Forms 1099 to contractors?
*
Yes
No
Total contractor payments made during the year
Inventory & Cost of Goods Sold
Does your business sell products?
*
Yes
No
Beginning inventory
Ending inventory
Purchases for resale
Other cost of goods sold items
Materials
Direct labor
Freight-in
Packaging
Storage
Other
Partnership / Corporation Details
Business entity type
*
Partnership
S Corporation
C Corporation
Other
Owners / Shareholders / Partners
*
Total capital contributions during the year
Total distributions / draws during the year
Officer / shareholder compensation paid
Shareholder health insurance paid by the business
None
Owner-Only Coverage
Family Coverage
Other
Loans to or from owners
No owner loans
Loan to owner
Loan from owner
Both
Other
Basis / K-1 records available
Capital account schedule
Basis worksheet
K-1 forms
Prior-year tax basis records
Other
K-1 / partner / shareholder details and notes
Rental / Business Property
Property Type
*
Residential Rental
Commercial Rental
Business-Owned Property
Vacant Land
Mixed-Use Property
Other
Property Details
Documents & Secure Uploads
Documents to Upload
Secure Upload Notice
Upload Supporting Documents
Upload a File
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Client Authorization & Signature
Client questions or comments
Preferred contact method
*
Email
Phone
Text message
No preference
Authorization for Diverse Tax Gem to contact me regarding tax preparation
*
I authorize contact by email
I authorize contact by phone
I authorize contact by text message
Client certification
*
Information provided is complete and accurate to the best of my knowledge
I have reviewed the information and will provide updates if anything changes
I understand eligibility for deductions and credits depends on tax law and supporting facts
Typed legal name
*
First Name
Middle Name
Last Name
Electronic signature
*
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
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