2024-2025 Intake Form

2024-2025 Client Intake Form
Taxpayer first and last name

First NameLast Name
Taxpayer Date of birth

MonthDayYear
Date
Taxpayer Social Security Number
Taxpayer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer email address
example@example.com
Taxpayer phone number
Please enter a valid phone number.
Taxpayer Occupation
Spouse first and last name

First NameLast Name
Spouse date of birth

MonthDayYear
Date
Spouse social security number

MonthDayYear
Date
Spouse Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse email address
example@example.com
Spouse phone number
example@example.com
Spouse occupation
Are you a new or existing client?
How did you hear about Atlanta Tax Break?
If referred, who referred you?
Were You Issued An Identity Protection Pin (IP Pin) By The IRS?
Enter Your Identity Protection Pin Here
Filing Status
Taxpayers ID or drivers license

Cancelof
Head of household documents

Please upload a December 2024 utility bill, lease agreement, or other household documents to prove expenses.
Cancelof
Do you have income? What type of income do you have?
Would you like to apply for a cash advance up to $7,000?

YesNoNot sure, show me the terms
Are You Filing A Business/Self Employed/Side Job/Cash Job? If yes, please describe the nature.
Is This Your First Year Filing This Business/Self Employed/Side Job/Cash Job?
Do you owe student loans, taxes, or other entities that might offset your refund? Please call this number to be sure 800-304-3107.

YesNo
Did you or your family have health insurance at any time in 2023 FROM THE MARKETPLACE? HEALTHCARE.GOV

YesNo
Do You Need Life Insurance?

Dependent Information
How many dependents are you claiming?

0123+
Dependent #1 First and last name

First NameLast Name
Dependent 1 DOB

MonthDayYear
Date
Dependent 1 SSN
Relationship to dependent #1
Dependent #1 SSN card

Cancelof
Dependent #2 first and last name

First NameLast Name
Dependent #2 DOB

MonthDayYear
Date
Dependent #2 SSN
Relationship to dependent #2
Dependent #2 SSN card

Cancelof
Dependent #3 first and last name

First NameLast Name
Dependent #3 DOB

MonthDayYear
Date
Dependent #3 SSN
Relationship to dependent #3
Dependent #3 SSN card

Cancelof
Dependent #4 first and last name

First NameLast Name
Dependent #4 DOB

MonthDayYear
Date
Dependent #4 SSN
Your relationship to dependent #4
Dependent #4 SSN card

Cancelof

Income
Make a selection
Upload your income documents

We need the entire form, with all numbers showing. Please take clear pictures.
Cancelof

Healthcare
Did You Purchase Any Health Insurance or Have Any Premium Credits From The Insurance Company That You Used?*

YesNo
Upload 1095-A

If you have Insurance through your job (1095B) or Insurance through your state (Medicaid) (1095C) You do not need these forms in order to file only the 1095A.
Cancelof
Do you need health insurance?

YesNo
Would you like a quote for health insurance?

YesNo

Refund advance application
Would you like to apply for the advance up to $7000? (It all depends on the amount of your refund). There we offer In-Season refund advances when the IRS opens.

Whatever method you use for refund advance, you'll receive the refund the same way! It can't be changed even if you're denied.

In Season- Approval rate 93%. Easier to get. Refund history from previous year. 9 out of 10 of my clients receive it. If you are denied, there is not any more funding until the IRS pays out your refund.

**DISCLAIMER: DESPITE ODDS, REFUND ADVANCES ARE NOT GUARANTEED**

THE BANK CAN APPROVE YOU FOR THE AMOUNT REQUESTED, DENY YOU, OR APPROVE YOU FOR A LESSER AMOUNT.
Would you like to apply?

YesNo
How would you like to receive it?

CheckPrepaid debit cardDirect deposit (quickest option)
How much would you like?

Less than $1,000More than $1,000
Acknowledgment*

I understand that the refund advance is not guaranteed and that loans over $1,000 will have small interest fee.I do not agree, I opt out of refund advance.

Refund selection
How would you like your refund?
How would you like to receive your debit card?
If you selected prepaid debit card as option above
How would you like to receive your check?
If you selected printed check as option above
Direct deposit bank name
Bank account type

CheckingSavings
Routing number
Confirm Routing number
Bank account number
Confirm Bank account number
Consent to Cash Advance By Typing Your Full Name Below
I agree that B. Brown's Tax Preparation & Bookkeeping, LLC and their Tax Banks has my permission to credit my account with my Cash Advance. I also agree that if my refund is offset for any reason B. Brown's Tax Preparation & Bookkeeping, LLC has my permission to withdraw from my account on file.

2024 Engagement letter
This letter is to confirm and specify the terms of our engagement with you and clarify the nature and extent of the services we will provide. In order to ensure an understanding of our mutual responsibilities, we ask all clients for whom returns are prepared to confirm the following arrangements:

We will prepare your 2024 federal and state income tax returns based on the information you furnish to us. We will not audit or otherwise verify the data you submit, although it may be necessary to ask you for clarification of some information. We will furnish you with questionnaires and worksheets to guide you in gathering the necessary information. Your use of forms will assist in keeping the fee to a minimum.

It is your responsibility to provide all the information required for the preparation of complete and accurate returns. You should retain all the documents, cancelled checks, and other data that form the basis of your income and deductions. These may be necessary to prove the accuracy and completeness of the returns to a taxing authority.

You have the final responsibility for the income tax returns, and therefore, you should review them carefully before you sign them. Our work in connection with the preparation of your income tax returns does not include any procedures designed to discover defalcations and/or irregularities, should any exist.

We are responsible for preparing the returns referred to in this letter. Our fee does not include responding to inquiries from the IRS or state received after the return is filed or examination by taxing authorities. However, we are available to represent you should such a need develop, and this would be covered under a separate engagement letter unless you opted into our Audit Protection Program.

We will render bookkeeping assistance as determined to be necessary for the preparation of the income tax returns.

Our fee for these services will be calculated based on our standard form based fee schedule.

All invoices are due and payable upon presentation. If you choose to disengage after your tax return has been accurately prepared and presented, there is a $100 tax quote fee required. We are dedicated to getting you every tax deduction and credit that you are eligible for. Your return is unique to your circumstances. We cannot guarantee the outcome or whether you will view it as good or bad. This does not relieve you of the obligation to pay our fees. Payment for services is due when rendered.

If the foregoing fairly sets forth your understanding, please sign.

We want to express our appreciation for this opportunity to work with you. We look forward to a long, mutually beneficial professional relationship with you.
Full name of taxpayer

First NameLast Name
Taxpayer Signature

Clear
Date

MonthDayYear
Date

end
Should be Empty:

2024-2025 Client Intake Form