Client Intake Form
2024 Tax Year
Are You An Existing or New Client?
Please Select
Existing
New
Filing Status
Please Select
Single
Head of Household
Married filing jointly
Married filing separately
Widow with dependent child
Do You Have Any Unfiled Tax Returns from Previous Years?
Please Select
Yes
No, All of my returns are up to date
Name
First Name
Last Name
Email
example@example.com
Did you use the same email address last year? If not, type email address here.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Do you rent or own your current residence?
Please Select
Rent
Own
Was your main home located in the federal declared disaster area and were you or your spouse displaced from your home in 2024
Please Select
Yes
No
Were you, your spouse or dependents issued an Identity Protection Pin (IP PIN)?
Please Select
Yes
No, I/We were not issued an IPPIN
If You, Your Spouse or Dependents Have an IPPIN , Please Provide It Here. Otherwise, Write N/A In The Box Below.
Will You Be Filing Your Return With Your Spouse?
Do You Have Any Dependents You Will Claim On Your 2024 Return? If Yes, Please List Their Names, Date of Birth and Social(s) Below.
Upload Dependent’s Birth Certificates, Socials, or any other identification documents
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Did you make any estimated tax payments for 2024 tax year?
Are you required to file state taxes? If Yes, Did You File State Taxes Last Year?
If you file state taxes, in what county do you reside? (Do not file state taxes, type N/A)
Do you want to donate $3 to the Presidental Campaign Fund? This Donation Will Not reduce your refund amount.
Did the Taxpayer work in 2024?
If Yes, What’s Your Occupation Title?
UPLOAD all Tax Documents Here (Driver’s License, Social, W-2, 1099, etc)
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Did You, Your Spouse Or Any Dependents attend College in 2024?
Please Select
Yes
No
If Yes, Please Attach Your School Documents Here (1098-T, Etc)
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Has An Educational Credit Been Claimed For 4 years?
Please Select
Yes
No
Not Applicable
Did You or Anyone in Your Household Receive Healthcare Marketplace Insurance in 2024? (IRS WILL NOT ACCEPT RETURN IF THIS DOCUMENT IS MISSING)
Please Select
Yes
No
Not Sure
Upload Healthcare Marketplace 1095-A Here, If Applicable:
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Did Anyone In Your Household Receive Unemployment Benefits in 2024?
Do You Owe The IRS?
Please Select
Yes
No
Not Sure
Did anyone included on return make student loan payments in 2024
Please Select
Yes
No
Did You or Your Spouse Pay Any Medical or Dental Expenses in 2024?
Please Select
Yes
No
Do You Or Your Spouse Own A Rental Property
Please Select
Yes
No
Did You or Your Spouse Have Any Gambling Winnings in 2024?
Please Select
Yes
No
Upload Form W2-G (Certain Gambling Winnings), If Applicable:
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Did You Or Your Spouse Receive Any Social Security Benefits?
Please Select
Yes
No
Did you or your spouse make any Charitable contributions in 2024?
Please Select
Yes
No
Did you or your spouse purchase a vehicle OR electric vehicle in 2024? If Yes, Please locate your Bill of Sale before your consultation with your tax professional.
Please Select
Yes
No
Did you or your spouse sell, acquire, send, receive or exchange any virtual currency?
Please Select
Yes
No
Did you or your spouse withdraw money from their 401k in 2024?
Please Select
Yes
No
Did you or your spouse receive any earnings from interest or dividends in 2024?
Please Select
Yes
No
Are You or Your Spouse Self Employed?
Please Select
Yes
No
Do You Plan To Purchase A Home In The Next Year or Two Years?
Please Select
Yes
No
Any Additional Documents Upload Here (Business Registrations, EIN numbers, School Documents, Etc)
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Would You Like To Apply For The Advance Loan?
Please Select
Yes
No
Would You Like Your Refund Direct Deposited Into Your Account?
Please Select
Yes
No
If You Would Like Your Refund Direct Deposited, Please Provide Your Bank Name, Account And Routing Number Here. If Not, Write N/A below.
For Banking Verification, Please Select One Of The Following Security Questions:
What Is Your Mother's Maiden Name?
What Is The Name Of Your First Pet?
What Is The Name Of Your High School?
What Is The Name Of Your Oldest Child?
What Is Your Father's Middle Name?
Type Your Answer To Selected Security Question Here:
How Did You Hear About Chosen 4 U Services Inc?
Please Select
Returning Client
Referral
Social Media (Facebook, Instagram, Twitter, Etc)
In Person Contact
Relative
If You Are A New Client Who Was Referred, Please Place The Referral Code Or The First and Last Name Of Who Referred You In The Box Below:
By Signing This Form, You are stating that all documents and information is current and accurately filled out by the tax payer.
THANK YOU !
Please Allow 24-48 Hours To Hear From Your Agent With A Respond After Submission.
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