Sharlena Taylor Services Client Intake Form

Were you referred? Yes No If yes, please type referral name Type Full Name (First and Last Name)
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Email
example@example.com
Mobile Number
Please enter a valid phone number.
Social Security Number
Social Security Number
Please enter a valid phone number.
Occupation
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is the address provided the same used as last years tax return?*

YesNo
IRS PIN number
Only Fill in if IRS provided this number
Drivers License Number
DL Number
Drivers License Issue Date

MonthDayYear
Issue Date
Drivers License Expiration Date

MonthDayYear
Expiration Date
Drivers License State
State

Self-Employed Income

Job #1 (If NONE hit "NEXT/SKIP" at bottom right)
Job Description
Job Description/Job Title
Number of Months on Job
1-12
DBA Name
Income Received
Income Received
EIN Number
If you have a EIN Number
Do you need to add another SELF-EMPLOYED job?

YesNo

Self-Employed Income

Job #2
Job Description
Job Description/Job Title
Number of Months on Job
1-12
DBA Name
Income Received
Income Received
EIN Number
If you have an EIN Number
Do you need to add another SELF-EMPLOYED job?

YesNo

Self-Employed Income

Job #3
Job Description
Job Description/Job Title
Number of Months on Job
1-12
DBA Name
Income Received
Income Received
EIN Number
If you have an EIN Number

Household Income (i.e housekeepers, babysitters/nanny,gardners etc.)

Job #1 (Employee Not a Independent Contractor) (If none hit "NEXT/SKIP" at bottom right)
Job Description
Job Description/Job Title
Name of Person you worked for
Full Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Income Received
Amount can't exceed $2,000
Do you need to add another HOUSE HOLD job?

YesNo

Household Income (i.e housekeepers, babysitters/nanny,gardners etc.)

Job #2 (Employee Not a Independent Contractor)
Job Description
Job Description/Job Title
Name of Person you worked for
Full Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Income Received
Amount can't exceed $2,000
Do you need to add another HOUSE HOLD job?

YesNo

Household Income (i.e housekeepers, babysitters/nanny,gardners etc.)

Job #3 (Employee Not a Independent Contractor)
Job Description
Job Description/Job Title
Name of Person you worked for
Full Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Income Received
Amount can't exceed $2,000

Education

Include Expenses for a Child Dependent as well. (If none hit "SKIP" at bottom right)
College Name
Full Name of School
College Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Total Amount Spent on School Supplies
Did you attend school for more than half of year?

YesNo
Do you have a 1098-T Form?

YesNoOther

Dependents

Dependent #4
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Social Security Number
Relationship
Disabled?

YesNo
Did you provide 50% or more support for Dependent #4?

YesNo
Did Dependent #4 live with you for more than half of the year?

YesNo
If Yes, please explain anyone else is claiming or allowed to claim Dependent #4...
Is anyone else claiming or allowed to claim Dependents #4 ?

YesNo

Loan Advance
Are you applying for a loan advance?*

YesNo
Refund Disbursement Option (Choose One)*

Refund CheckDirect Deposit

Direct Deposit Banking Information

	Bank Name	Routing Number	Account number	Checking/Savings
Direct Deposit Information

Documentation Upload

Use this section to upload ID Cards, W-2's, Social Security Cards, Birth Certificates, Pay Stubs, etc. (CAN UPLOAD MULTIPLE FILES)
Identification

DL, Identification,Passport
Cancelof
Birth Certificate

Cancelof
Income Documents

Pay Stubs, 1099, W2 etc..
Cancelof
Social Security Card

Social Security Card
Cancelof
Other

Additional Documents
Cancelof
Other

Additional Documents
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Signature Page

Acknowledgement Clause
By signing below I, First Name* Last Name* agree to give Sharlena Taylor LLC the authority to use my information provided for tax preparation purposes ONLY. All information submitted by me "the taxpayer" is true and accurate to the best of my knowledge.
I understand that I am financially responsible for any outstanding balance due to any false information given. If there is a balance due, you must pay the tax preparation fee upfront. If for any reason you owe an entity and they take the entire refund, you are STILL responsible to pay the tax preparation fee for services rendered.

*For any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $150.00 is required! Please view your tax return, which is emailed to you. Any copy after the first copy is a fee of $10.00.

ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS TO THIS!!

Please utilize www.irs.gov for all federal refund tracking. Please utilize your state Department of Revenue site for any State Refund tracking. Do NOT add the amounts together. Federal taxes are federal, and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions.
IRS Contact 800-829-1040

Please click this link to check your federal refund status. You will need your filing status, social security number, and the total amount of the refund before fees
https://sa.www4.irs.gov/irfof/lang/en/irfofgetstatus.jsp
Signature*

Clear
Should be Empty:

Self-Employed Income

Self-Employed Income

Self-Employed Income

Household Income (i.e housekeepers, babysitters/nanny,gardners etc.)

Household Income (i.e housekeepers, babysitters/nanny,gardners etc.)

Household Income (i.e housekeepers, babysitters/nanny,gardners etc.)

Education

Dependents

Dependents

Dependents

Dependents

Loan Advance

Documentation Upload

Signature Page