Tax Client Intake Form
Taxpayer Information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Current Tax Year
Did you file with us last year?
Yes
No
Marital Status
Never Married
Married
Divorced
Legally Separated
Widowed
Filing Status
Single
Married Filing Jointly
Married Filing Separately
Head of Household
Qualifying Surviving Spouse
S-S-N
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you a U.S. Citizen or green card holder?
Yes
No
Occupation
Are you filing an eligible spouse on your return?
Yes
No
Are you a full-time student?
Yes
No
Are you totally and permanently disabled?
Yes
No
Are you legally blind?
Yes
No
Are you eligible to be claimed as a dependent by any other person(s)?
Yes
No
Do you have a Tax ID PIN?
Yes
No
Proof Of ID: Dri.vers Li.cense, Pass-port, ID-Card
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Tax ID PIN
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Spouse & Dependents Information
Spouse Name
First Name
Last Name
Spouse Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Spouse Email
example@example.com
Spouse's S S N
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Is your spouse a full-time student?
Yes
No
Is your spouse totally and permanently disabled?
Yes
No
Is this individual a dependent of another?
Yes
No
Are you claiming any dependents?
Yes
No
Dependent Information
Dependent 1 Name, Dependent 1 SSN#, Dependent 1 Date of Birth, Dependent 1 Relationship:
Dependent 1 Birth Certificate(s)
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Dependent 1 SSN Card
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Dependent 1 Report Card(s)
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Dependent 2 Name, Dependent 2 SSN#, Dependent 2 Date of Birth, Dependent 2 Relationship:
Dependent 2 Birth Certificate(s)
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Dependent 2 SSN Card
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Dependent 2 Report Card(s)
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Dependent 3 Name, Dependent 3 SSN#, Dependent 3 Date of Birth, Dependent 3 Relationship:
Dependent 3 Birth Certificate(s)
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Dependent 3 SSN Card
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Dependent 3 Report Card(s)
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Dependent 4 Name, Dependent 4 SSN#, Dependent 4 Date of Birth, Dependent 4 Relationship:
Dependent 4 Birth Certificate(s)
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Dependent 4 SSN Card
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Dependent 4 Report Card(s)
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If any of your dependents are disabled list them here:
Tax Related Questions
Employment Status
Employed
Unemployed
Self-employed
Is this your first time opening a pre-tax account?
Yes
No
Does your dependents have tuition expenses?
Yes
No
Are you currently renting?
Yes
No
What is the monthly rental amount?
Do you own your home?
Yes
No
Do you have documents that show you paid for property taxes?
Yes
No
How long have you lived at the property?
Did you take money from your 401?
Yes
No
Do you have mortgage interest?
Yes
No
Do you have real estate tax?
Yes
No
Did you receive a federal tax last year?
Yes
No
Are you a victim of identity theft?
Yes
No
Income
Please select all forms of income in the current tax year:
Wages or Salary (W2 Income)
Unemployment
Pension/Retirement Income
Rental Income
Farm Income
Dividend/Sale of Stocks
Interest Income
Self-Employment–Bus. Income (Sch.C)(1099)
Alimony Received
Lottery or Gambling Income W-2G
Public/State Aid Income
Social Security Income
Tips
Other
Expense
Please select which other expenses pertain to you:
IRAs
Property Tax
Mortgage Points (closing points)
Business Owner/Self Employed
Tax Prep Expenses
Union Dues
Education Expenses
Significant Loss or Theft
Charity or Religious Contributions
Mortgage Investment
Moving Expenses
Medical Expenses
Alimony Paid
Bought or Sold Home
Job Related Expenses
Other
General Expenses
Rows
Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses
Total Expenses
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Did you have health insurance through the Marketplace?
Yes
No
Do you have expenses from a business?
Yes
No
Do you have receipts and documentation for the expenses?
Yes
No
Upload the documents of business expenses?
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Upload Form 1095-A
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Dependent(s) 1095-A Form
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Dri.ver Li.cense, Pass-port, ID Cards
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Bank Information: Routing and Account Number
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Would you like a tax advance?
Yes
No
Upload W2 Form
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Additional Tax Documents
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Authorization & Consent
I confirmed that all information I entered here is accurate and true.
I allow Infiniti Tax to capture my data like per.sonal id, govern.ment id, (SSN), and other information.
I have read the terms and conditions and privacy policy of Infiniti Tax.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Taxpayer Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Spouse Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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