Intake Form Tax Refund

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LETS GET READY TO FILE - DOCUMENT CHECKLIST!You will be asked to upload any applicable documents at the end of this form.
VALID Photo ID OR DRIVERS LICENSE
W2 and/ or 1099 FORM
SELF EMPLOYED INCOME AND EXPENSES
SOCIAL SECUIRTY CARDS OR BIRTH CERTIFICATE FOR DEPENDENTS
CHILDCARE EXPENSES OR PROVIDER INFORMATION
CHARITY CONTRIBUTIONS
1095A FORM (MARKET PLACE INSURANCE) Login to healthcare.gov or call 1800-318-2596 to retrieve
1098T FORM (COLLEGE TUITION )
1099-G (UNEMPLOYMENT INCOME)
W-2G GAMBLING OR LOTTTERY WINNINGS
INTEREST INCOME FROM SAVINGS
RENTAL PROPERTY INOMCE
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Filing Status* This field is required.Select the filing status you expect to use for your return. If unsure, choose the option that best fit your situation.
Single
Head of Household
Married Filing Single
Married Filing Jointly
Qualifying Widower
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Are you a new or returning client?* This field is required.
New
Returning
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Primary Flier- Full Legal Name * This field is required.Enter name as it appears on your social security number
First Name
Last Name
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Date of Birth* This field is required.
Date
Year
Month
Day
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SSN* This field is required.Social security Number
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Email* This field is required.(used for document requests, and or e-signature notifications.
example@example.com
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Phone Number* This field is required.
Area Code
Phone Number
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Primary Filer -Taxpayer Address* This field is required.This must be current mailing address. The IRS may use this address to send verification letters or security code if needed.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
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
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Employment Status* This field is required.This helps us identify the right income forms and prepare your return accurately.
Employed
Unemployed
Self Employed
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Occupation* This field is required.Enter your primary job title or type of work (for example; teacher, nurse, self employed hairstylist, contractor delivery driver).
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Are you self-employed or a business owner?* This field is required.This includes hairstylist, babysitters, freelancers, content creators, gig workers, independent contractors, drivers, nail techs etc.
YESNO
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Total Self Employment Income* This field is required.Include cash, checks, Zelle, Cash App, Venmo, Paypal or other payments. Please upload supporting documents.
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Total Self Employment Expenses?* This field is required.Cost of doing business. Example: supplies, advertisement, subscription, equipment cost.
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Were you referred to us by someone? Please enter referral name.* This field is required.If yes, please enter the name of the person who referred you. Otherwise you may lease this blank.
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Were you a full-time student at any time during 2025?* This field is required.If "Yes" upload school records such as form 1098-T, enrollment verification, or letter from the educational institution..
YESNO
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Do you have a permanent or long term disability recognized recognized for tax purposes?* This field is required.If "Yes" please provide documentation that supports this status, such as doctor's statement, SSA, determination, or other official records documents can be uploaded later. .
YESNO
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Are you legally blind as defined by the IRS?* This field is required.IRS rules require documentation to claim certain disability or blindness- related tax benefits. If you selected "Yes," supporting documents can be uploaded before submission.
YESNO
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How much was your federal tax refund last year? (estimate)* This field is required.If you don't remember, a rough estimate is okay.
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Did you contribute to a 401k or other pre-tax retirement account during the tax year?* This field is required.This includes any pre-tax retirement contributions made through and employer or qualified retirement plan during the tax year.
YESNO
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Can someone else claim you as a dependent?* This field is required.This incudes being claimed by a parent, guardian, or another taxpayer
YESNO
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Would like to be considered for a refund advance?* This field is required.If approved, you may receive a portion of your refund early. Approval and amounts are determined by the bank, not the preparer.
YESNO
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Refund Advance Options* This field is required.Interest rates, terms and eligibility is determined by the bank, not the preparer.
up to $1000 with no interest
up to $7500 with interest (interest amount is based on the bank)
Not interested
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How would you like to receive your tax refund?* This field is required.Available options depend on eligibility and bank processing times.
Please Select
Please Select
Bank Account
Check
Fast Money Card (up to 4 days early)
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Bank Name Enter the name of bank you would like your refund deposited
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Bank Account Number This information is used only for direct deposit of your tax refund
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Bank Routing NumberYour bank's 9 digit routing number
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Do you have an IRS identity Protection PIN (IP PIN)?* This field is required.An IP PIN is a six digit number issued by the IRS to protect your tax account. Enter your 6-digit IP PIN exactly as provided by the IRS.( call 800-908-4490 to retrieve PIN)
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Mother's Maiden Name?* This field is required.Used as an additional identity verification step when required.
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Are you Married filing jointly?* This field is required.Select "Yes" if you and your spouse are filing one joint return together. Select "No" if you are filing separately or single.
YESNO
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Spouse This sections is required only if you are filing a Married Filing Jointly return.
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How many dependents are you claiming?
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Dependent Information- First DependentPlease provide information for each dependent you plan to claim on your tax return.
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Dependent Information- Second DependentPlease provide information for each dependent you plan to claim on your tax return.
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Dependent Information- Third DependentPlease provide information for each dependent you plan to claim on your tax return.
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Dependent Information- Fourth DependentPlease provide information for each dependent you plan to claim on your tax return.
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Did you pay for childcare or daycare for any of dependents so you can could work or attend school?* This field is required.If "Yes' upload documentation such as daycare invoices, receipts, or a statement showing provider's name, address, and EIN or Social Security Number
YESNO
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Were any of the dependents a full-time student at anytime during 2025? (college/ vocational, or trade school)* This field is required.If "Yes" upload schools records such as form 1098-T enrollment varication, or letter from the educational institution.
YESNO
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Does any of the dependents have a permanent disability?* This field is required.If 'Yes" upload doctor's statement, Social Security determination, or other official records.
YESNO
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Do any dependents have an IRS Identity Protection PIN. (IP PIN).If 'Yes" Please enter the 6-digit pin and dependent name who have one. If you need to request pin please visit: https://www.irs.gov/identity-theft-fraud-scams/retrieve-your-ip-pin or call 1800-908-4490.
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Which tax return would you like us to prepare?Select all that apply. State returns are only required if you lived or worked in a state with income tax.
Federal
State
Local
RITA
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What type of health Insurance did you have during the tax year?This helps determine if any forms or credits apply. If you select Marketplace, please don't forget upload form 1095A.
None
Job Related
Medicaid
Medicare
Marketplace (ACA)- Login to healthcare.gov or call 1800-318-2596 to retrieve 1095-A form
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Did you pay student loan interest?* This field is required.If 'Yes' upload Student loan interest statement form 1098-E provided by loan servicer,
YESNO
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Did you own a home at anytime during the tax year?* This field is required.If "Yes" upload Mortgage interest statement (form1098), property tax statement, closing disclosure, or settlement statement.
YESNO
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Did you sale any stocks, cryptocurrency or other investments during the tax yearIf "Yes" upload Brokerage sales form 1099-B, Dividends form 1099- DIV, Interest form 1099-INT, (if applicable)
YESNO
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Did you take money out of a retirement account during the tax year?* This field is required.If "Yes" please upload form 1099-R for each retirement account withdrawal, rollover or distribution. This form is required to accurately report taxable and non-taxable retirement income to the IRS..
YESNO
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Would you like to Enroll in Credit Restoration Services? (Optional)* This field is required.Service fee: $500 for 6 months of credit repair services. Includes comprehensive credit report analysis, personalized action plan, dispute assistance, progress monitoring, and client support..
Yes. Enroll me in credit repair services and I authorize payment from tax refund (if eligible.)
Yes. I would like to enroll in credit restoration services and will pay outside my tax refund.
I decline credit repair services at this time
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Do you need assistance buying or selling a home within the next 12 months?* This field is required.Optional real estate services available for clients planning to buy, sell, or lease within the next 12 months.
Yes- Buying
Yes- Selling
Yes- Finding a Rental
Yes- I want to Lease my home out
No, thankyou
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Would you like to schedule a phone appointment to review information or ask questions?* This field is required.
YESNO
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Schedule a Call If you'd like to review your information or ask any questions, you may schedule a quick call. This step is optional your return tax return will be prepared and securely sent to you for review and electronic signature before it is filed with the IRS. No return is submitted without your approval.
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Client Acknowledgement & Authorization* This field is required.Please confirm.
I confirm that the information I provided is complete and accurate to the best of my knowledge, and I agree to upload all required documents to proceed with tax preparation.
I understand that no return will be filled without my review and approval.
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I authorize Signature Tax Solutions/ All Profitz Calculated Tax Service to collect my personal information for the purpose or preparing and filing my tax return.* This field is required.All information is handled securely and in accordance with IRS guidelines.
Yes
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Please upload any tax documents that apply to you for this filing year. * This field is required.Examples: License, W2, !099, health forms, tuition expense form, child care expense form social security income, dependents social security card, dependent school records or shot records. Cashapp statements, Zelle etc, Profit and loss statement. Utility bill for proof of address
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Signature* This field is required.
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