Tax Intake Form

CLIENT FORM
How did you hear about us?

FacebookInstagramReferralPrevious Client
Tax Payers Name

First NameLast Name
If someone referred you, please type his or her name here.
Taxpayer's Phone Number*
Example: xxx-xxx-xxxx
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer's Driver's License

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Taxpayer's Social Security Card(s)

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Taxpayer's Date of Birth*
Example: 01/01/2001
Taxpayer's SSN
Example: xxx-xx-xxxx
Taxpayer's Email Address*
Spouse's Full Name
First Name
Spouse's SSN
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
Taxpayer's W-2/ 1099'S

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Are you self employed?*

YesNo
Name of your business?
Example: IFS Tax Prep
How much did you make for the year with self employment?
Example: $20,000
How much was your expenses for the year with self employment?
Example: $6,000
Self employment records/ receipts

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Example: Cash app transactions/bank statements/receipts Cancelof
Did you support a child or family member for more than 6 months out of the year?*

YesNo
How many dependents are you claiming?*
Dependent(s ) Social Security Card(s)

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Dependent(s) Birth Certificate(s)

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Dependent #1

First NameLast Name
Dependent #1 Date of Birth
01/01/2001
Dependent #1 SSN
What is Dependent #1's Relationship to you (son, daughter, etc.)?
Dependent #2

First NameLast Name
Dependent #2 Date of Birth
Example: 01/01/2001
Dependent #2 SSN
What is Dependent #2's Relationship to you (son, daughter, etc.)?
Dependent #3

First NameLast Name
Dependent #3's Date of Birth
01/01/2001
Dependent's #3 SSN
What is Dependent #3's Relationship to you (son, daughter, etc.)?
Dependent #4

First NameLast Name
Dependent #4's Date of Birth
01/01/2001
Dependent #4's SSN
Example: xxx-xx-xxxx
What is Dependent #4's Relationship to you (son, daughter, etc.)?
Dependent #5

First NameLast Name
Dependent #5's Date of Birth
01/01/2001
Dependent #5's SSN
Example: xxx-xx-xxxx
What is Dependent #5's Relationship to you (son, daughter, etc.)?
Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.

YesNo
Upload a copy of your daycare form here.

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How would you like to receive your tax refund?

Check (Only available for in office visits)Direct Deposit
Which type of account would you like your refund deposited into?

Checking AccountSavings AccountOther
Routing Number
Bank Account Number
Did you have health insurance in 2024?

YesNo
Was your insurance through the Affordable Care Act (The Marketplace)?*

YesNo
Were you or any of your dependents in college in 2024?

YesNo
If you have a 1098-T form, upload it here.

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Are you interested in AUDIT PROTECTION?

YesNo
CLIENT NON PAYMENT/OFFSET CLAUSE

At Intentional Financial Solutions, 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.
I am giving Intentional Financial Solutions permission to prepare all forms related to my tax return; to file on my behalf; and file my taxes electronically. I take full responsibility for the accuracy of this form and understand that Intentional Financial Solutions and/or associated affiliates hold no responsibility for any misrepresentation or false claims.
ADDITIONAL SERVICES

At Intentional Financial Solutions, we do more than just taxes. Please comment below if you would be interested in any of the additional services we provide. We will schedule a time to speak with you at a later time.
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Primary Taxpayer's Signature

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