Cole and Grogan Client Intake Form

Client Intake Form
Thank You for taking the time to complete your Client Intake Form. This information is critical to ensure your tax return is filed accurately. Please take your time and review all information before you submit. Please note that if documents are missing or information is incorrect this will result in a delay in processing your return.

This intake form will take 20- 30 minutes to complete.

Please complete this form in its ENTIRETY and click SUBMIT when finished. Upload all documents at the end of the form.

Please wait until you have ALL of your documents before submitting this form. ALL INCOMPLETE FORMS WILL NOT BE FILED UNTIL ALL CURRENT AND VALID DOCUMENTS HAVE BEEN PROVIDED.

Note: If you are claiming any dependents, be sure to upload their SS CARDS, BIRTH CERTIFICATES, and all items that show their address is the same as yours. (e.g. school records, medical records, doctor bills, Medicaid Statement, Social Services Records, or anything that shows your child's name and current address).

PLEASE READ THROUGH ITS ENTERITY.

DO NOT SUBMIT THIS FORM UNTIL YOU HAVE ALL SUPPORTING DOCUMENTS.

BY NOT FOLLOWING DIRECTIONS YOUR INTAKE FORM WILL NOT BE PROCESSED.

IT WILL BE A WASTE OF YOUR TIME AND OURS.

BE SURE ALL SUPPORTING DOCUMENTS ARE VALID AND CURRENT.

BE SURE LEASE AND OTHER FORMS HAVE THE DEPENDENTS NAME ON THEM IF APPLICABLE.
How did you hear about us?
If someone referred you, please type his or her name here.
If you are filing multiple years you must complete a separate form for each year.
Which Tax Year Are You Filing For?

SPOUSE'S INFORMATION
Spouse's Full Name
First Name
Spouse's Social Security
Example: xxx-xx-xxxx
Spouse's Date of Birth
Example: 01/01/2001
Spouse's Phone Number
Example: xxx-xxx-xxxx
Spouse's Email Address
Example: example@example.com
Spouse's Driver's License/State ID (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Please upload a Selfie of your spouse to validate their Government Issued ID.(In order for your selfie to be considered validated, you MUST have your ID in hand when submitting your selfie.)

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Spouse's Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Did you and your spouse live apart for more than 6 months in 2022?
What months?

INCOME
Upload W2 statements (Stand directly over the item on a flat surface and zoom in for a clear shot.)*

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1099 NEC (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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Did you receive unemployment during the year?
1099 Unemployment Taxpayer/Spouse (Stand directly over the item on a flat surface and zoom in for a clear shot.)*

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Upload other Misc. Income Documents such as 1099 INT, 1099 DIV, 1099 NEC. (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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CURRENT LIVING SITUATION
Do you receive Subsidized Housing or Section 8?
Do you receive any Government Assistance Programs such as Food stamps, TANF, Medicaid, or Medicare in during the year?
Which program(s) did you receive?
How much did you receive from the program(s).
Do you have a 1098 Mortgage Interest Statement?
Upload your 1098 Mortgage Interest Statement Here. (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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ATTENTION: Please take the time to carefully answer the questions below about the type of insurance you had. If you do not answer these questions correctly or forget to upload your 1095 A,B, OR C FORM. Your tax return will be REJECTED by the IRS. If you do not remember what kind of insurance you received, contact your employer to see.
Did you get your health insurance from the government that offers you health plans for cheaper prices. (If you did, then the government will send you a 1095 A form and you WILL NEED to provide us with a copy of your 1095 A)*

YES, I didNO, I did not
Was your insurance through a current employer, or state?*

EmployerStateNo insurance
Do you have 1095A, 1095B, or 1095C form?

YesNo
PLEASE UPLOAD YOUR 1095 A, B, or C Form IF APPLICABLE (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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Did anyone in your household attend college for the selected tax year? *
What was the Name of the person who attended college?
What was the name of the college they attended?
How many years has this person claimed AOTC?
Form 1098-T (School Credit) *Stand directly over the item on a flat surface and zoom in for a clear shot.

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ACKNOWLEDGMENT & SIGNATURE
Are you interested in Audit Protection? (Mandatory For ALL Schedule C'S)
STOP!

Did you finish uploading your documents?

IF YOU DID NOT UPLOAD ALL NECESSARY DOCUMENTS YOUR INTAKE FORM WILL BE VOIDED.
CLIENT NON-PAYMENT/OFFSET CLAUSE

At Cole & Grogan Accounting & Taxes, we strive to assist all of our clients in their tax needs, however, we understand that situations arise. If your refund is offset by the IRS, student loans, child support or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return.

By signing this agreement you acknowledge that if payment is not made in full within 30 days legal actions will be sought to resolve payment.
How would you like you refund dispersed ? (if you are not expecting a refund select N/A.)*

Direct DepositCheckBy MailN/A
Name of Bank
Routing Number
Bank Account Number
Is this this account a checkings or savings account?

CheckingSavings
Primary Taxpayer's Signature*

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Primary Taxpayer's Spouse Signature*

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I am giving Cole and Grogan Accounting & Taxes permission to prepare all forms related to my tax return. To apply for and secure RAC's and RAL's on my behalf, sign all necessary forms and file my taxes electronically. I take full responsibility for the accuracy of this form and understand that Cole and Grogan Accounting & Taxes and/or associated affiliates hold no responsibility for any misrepresentation or false claims.
Taxpayer's Signature

Clear
Date*

MonthDayYear
Date
Spouse's Signature (If no spouse, leave blank)

Clear
Date

MonthDayYear
Date
Form Status
BEFORE YOU SUBMIT GO BACK AND REVIEW

Make sure you have uploaded current and valid documents. If we find that you are missing documents or documents are not valid, we will place your return on hold and WILL NOT EFILE until we receive the proper documents.
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