Tax Preparation Client Intake Form

Driver's License or State ID #*
State ID Was Issued*
Date ID Was Issued *
MM/DD/YYYY
ID Expiration Date*
MM/DD/YYYY
Photo of Social Sec. Card & ID *

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Identification Cancelof
Please upload proof of residency. (such as rental agreement, mortgage statement, ect...)*

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Do you have an Identity Protection Pin issued by the IRS?*

YesNo
If yes, please upload your IP Pin from the IRS here.

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What was your filing status last year?*
Can someone else claim you as a dependent?*

YesNo
Were you married as of December 31, 2024?*

YesNo

Spouse Name*

First NameMiddle NameLast NameSuffix
Social Security Number*
Occupation*
Date of Birth*

MonthDayYear
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Driver's License #*
State Driver's License Was Issued*
Date Driver's License Was Issued *
MM/DD/YYYY
Driver's License Expiration Date*
MM/DD/YYYY
Photo of Driver's License and Social Security Card *

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Identification Cancelof

Child and Dependent Daycare Expenses

If the provider is a person, enter the care provider's SSN
Child Name Amount Paid*

First NameAmount Paid
Provider Phone Number*

Area CodePhone Number
Provider*

NameTax ID #/ SSN
Provider Address*

Street Address

Street Address Line 2

CityState

Zip Code
Do you want to enter another child care provider?*

YesNo
Child Name Amount Paid*

First NameAmount Paid
Provider*

NameTax ID #/ SSN
Provider Phone Number*

Area CodePhone Number
Provider Address*

Street Address

Street Address Line 2

CityState

Zip Code

Business Owners Data Sheet

Schedule C
Let's maximize your refund with benefits of being a business owner! Please answer the following:
Name of Business (Enter your name if no legal business name)*
Employer ID Number (Leave blank if using your ssn)
EIN
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What is the legal structure of your business?*
What is your NAICS code or business industry code? If you do not know please tell us what type of business this is.*
Amount of business taxes paid throughout the year?
$
What is the make and model of your vehicle used for business purposes?
What month, day, and year did you start using this vehicle for business use?
Business Income

All business income received during the year
Total Business Income
$
Business Expenses

Complete to the best of your ability. In each field enter the approximate amount you spent in each category.
Advertising
Social media, Flyers, Business Cards, etc
Contract Labor
An person or company paid to assist you
Insurance
(Other than health)
Interest
Mortgage, Loans, Credit Cards, etc.
Legal & Professional Services
Training, Conferences, Mentors, Lawyers, etc
Office Expenses
Software, postage, email, internet, and any operating expenses
Did you pay any commercial rent? If so, how much for the year? *
Rent and Lease
Vehicles, Machinery, Equipment, Electronics, Accessories, etc.
Repairs and Maintenance
Supplies
Objects used to operate your business
Taxes and Licenses
Travel, Meals, and Entertainment
Airfare, Uber, Taxi, Lyft, Business Dining, Business Entertainment, and etc.
Utilities
Did you work from home? If so, what is the square footage of your home? *
Other Expenses
Is there any other information, questions, or concerns that you want to include to your tax preparer pertaining to your business?
Attach any photos or documents that you want us to have on file.

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Health Insurance

Please make sure you answer this question to the best of your knowledge to avoid your refund being DELAYED!
Did you or any household member have health care coverage through Healthcare.gov or marketplace/Obama care during the tax year? (Form 1095A). If you are not sure, please call 800-318-2596 (open 24/7).*

YesNo
If yes, please upload your 1095A.

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Do you and/or your dependents have any medical bills? (this includes prescriptions, co-pays, vision and dental, etc...)*

YesNo
If so, how much for the year?
Do you pay for medical insurance out of pocket? If so, how much monthly? *

Additional Questions
Do you pay tithes to your church or make monetary donations to charity or non profit?*

YesNo
If so, how much for the year?
Do you pay for your parents living expenses including rent, mortgage, utilities, or medical bills?*

YesNo
If so, how much for the year?
Have you ever been disallowed certain credits or had them reduced in previous years such as EIC or education credits?*

YesNo
In the event you are locked out of your account, what is your mother's maiden name? *
Please Note: Upon completion and submission of this intake form, you are acknowledging your intent to file your taxes with Xtreme Financial Group with the knowledge that you are responsible for paying the preparation fees either upfront or via your refund and in the event that your refund is taken by the IRS for taxes owed or any other obligation, you are still responsible for paying the preparation fees. If you decide to go somewhere else, you are still responsible for paying the preparation fees for the work we have done in preparing your tax return. In this case, you are giving Xtreme Financial Group permission to debit your preparation fees from your bank account on file.

Upon signature and submission of this form, you acknowledge that you have read, understand, and agree to these terms.
By submitting this application, I acknowledge and agree to provide my personal information, including but not limited to my full name, date of birth, social security number, current address, banking information, and any other necessary details. I understand that this information is required for verification purposes, accurate tax return preparation, and to ensure the timely processing of any refunds, credits, or payments I may be eligible to receive. I confirm that all the information provided is accurate and up-to-date. I further consent to the use of this information solely for the purposes outlined above and acknowledge that it will be handled with the utmost confidentiality and in compliance with applicable laws. By checking the box and signing below, I confirm that I understand and consent.*
Please verify that you are human*
E- Signature Below*

Clear
By filling out this form, you are giving us permission to prepare your tax return and you are confirming that ALL information entered is accurate. If you have any questions do not hesitate to call our office at (833) 689-4140 or email info@xtremefinancialgroup.com
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Client Tax Data Sheet

Payment/Refund

Dependents

Child and Dependent Daycare Expenses

Income

Upload photos of your W-2,1099, and ALL Income documents

Business Owners Data Sheet

Business Income

Business Expenses

Multi-Member LLC and Partnership Tax Returns

Future Plans

Corporate Tax Returns

Future Plans

Expenses

Health Insurance

Additional Questions