Client Intake Form 2025 Tax Season
Please note: Our office does not provide free estimates or quotes. Every tax situation is unique, and accurate information can only be determined after a full review of your documents. Consultation fees apply to all services, which are credited toward your preparation fee once you proceed. Consultations fees are $150 per hour.
Client Engagement
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Notice Regarding Tax Preparation Services Please be advised that A Unique Experience, LLC does not provide free quotes or estimates. Once your intake form is received and work begins on your tax return, tax preparation fees will apply, regardless of whether you choose to file through our office. If you decide not to file with us after work has begun, you authorize A Unique Experience, LLC to deduct the applicable preparation fee and a non-refundable inconvenience fee. If your tax refund is intercepted or reduced due to obligations such as child support, student loans, unemployment overpayments, or wage garnishments, you remain responsible for payment of the preparation fee in full. By signing this engagement, you agree to pay all applicable preparation fees, regardless of refund status or outcome. Clients have 24 hours to communicate any questions, concerns, or changes regarding their decision to proceed. We encourage open communication to discuss any necessary arrangements in a timely manner. By signing below, you acknowledge that you have reviewed and understand the terms, conditions, and privacy policy of A Unique Experience, LLC, and accept your responsibilities and ours in the preparation and processing of your tax return.
PLEASE READ!
Do you understand that you are giving us permission to ACH Draft from your account in the event of you not filing with us or your refund has an offset?
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Who is your tax professional ?
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Please Select
Unique Rose (CEO)
Torrean Palmer
Cumekia Conner
Tamaia Wade
Shauna Dance
Niyah Rivers
Samantha Kight
Keirra Pratt
Latatyana Sims
Jannize Smith
Kathy Smith
Are you a new client?
Yes
No, returning client
If New, who Referred You to the company?
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Do you have any outstanding issues with the IRS, such as overdue student loans, unpaid child support, or tax liens? Please call (800) 304-3107 to verify. You will need to make an upfront deposit if you owe.
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Yes
No
Tax Year
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2025
2024
2023
2022
Social Security Number
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Phone Number
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-
Area Code
Phone Number
Were you married in 2025?
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Please Select
yes
no
I'm divorced (need marriage decree)
Occupation: example: Cashier, truck driver, self employed,assembler etc.
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what is your job title?
Email
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example@example.com
Do you have a dependent or dependents you are claiming this year?
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Please Select
yes
no
Are You Filing a Federal or State Tax Return?
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Federal
State
BOTH
Do you have an Identity Protection Pin issued by the IRS?
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Yes
No
If yes, please upload your IP Pin from the IRS here.
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Are you filing children on your tax return?
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yes
no
Tax Office Will Make Determination of your Filing Status
How Would You Like to Receive Your Refund?
Select below the method that you prefer to receive your refund
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Direct Deposit
Check
Account Type
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Checking
Savings
Bank Name:
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ADDRESS THAT THE IRS & MYSELF CAN SEND MAIL TO YOU!
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Bank Account Number:
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Bank Routing Number
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Please Upload A Selfie
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Choose a file
.
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Please UPLOAD a Picture of your Social Security Card/ Birth Certificate for Identification Purposes.
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Did you or your dependents attend a College or university or took post secondary education classes last year?
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Yes
No
Date of Birth
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/
Month
/
Day
Year
Date
Dependents
MUST SHOW PROOF! Birth certificate, social security card, leasing agreement, report card & shot records!
Image of All Dependent's S.S.Card
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Choose a file
Upload ALL here
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1. Dependent Information
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Gender
First Name
Middle Name
Last Name
Suffix
Date Of Birth
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-
Month
-
Day
Year
Date
Social Security Number
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Did you receive food stamps, SNAP Benefits, or TANF benefits in 2024? If so, how many months and how much were you receiving? Example: I received $754 in food stamps for 12 months.
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First Name
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Did you receive child support or did you pay child support in 2024? If so, how much did you receive? Example: I received 1200 in childsupport for 3 kids for 12 months
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Save
Middle Name
Date Of Birth
-
Month
-
Day
Year
Date
File Upload
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2. Dependent Information
Gender
First Name
Middle Name
Last Name
Suffix
Suffix
Jr, Sr, II, III
Did you receive Section 8 or housing voucher assistance in 2024? If so, please specify the number of months and the monthly amount paid. Example: I received Section 8 for 12 months, rent was 1200 and they paid $600
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Date Of Birth
-
Month
-
Day
Year
Date
Head of household filers must provide one of the following documents to qualify for this status. Please choose one of the two options below to submit for approval.
Utility Bill
Lease or Mortgage
Date Of Birth
-
Month
-
Day
Year
Date
3. Dependent Information
Gender
First Name
Middle Name
Last Name
Suffix
4. Dependent Information
Gender
First Name
Middle Name
Last Name
Suffix
Social Security Number
Social Security Number
Social Security Number
Who is Your Tax Professional?
*
Please Select
Unique Rose (CEO)
Tamaia Wade
Shauna Dance
(CiCi) Cumekia Conner
Torrean Palmer
Maurice TaxKing Carter
Please PAY ATTENTION to THE NAME you are SELECTING!
Upload photos of your W-2,1099, and ALL Income documents
Attach an image of all documents that can be used to assist your tax preparer with the preparation of your tax return.
Last Name
*
Upload All Income Documents Here
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Have you ever been disallowed certain credits or had them reduced in previous years such as EIC or education credits?
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Yes
No
Do you want to enter another dependent?
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Yes
No, all dependents are entered
Spouse Name
*
First Name
Middle Name
Last Name
Suffix
Are any of your children disabled?
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Yes
No
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Save
Social Security Number
*
Occupation
*
Date of Birth
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-
Month
-
Day
Year
Date
Phone Number
*
Email
*
example@example.com
Relationship
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Total Months Lived with you during the tax season??
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Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Driver's License #
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State Driver's License Was Issued
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Do you want to enter another dependent?
Yes
No, all dependents are entered
Spouse Information
Relationship
Total Months Lived with you during the tax season?
Date Driver's License Was Issued
*
MM/DD/YYYY
Driver's License Expiration Date
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MM/DD/YYYY
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Do you want to enter another dependent?
Yes
No, all dependents are entered
If you did not file your tax return with us last year, please upload a copy of your previous year's tax return
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HIGHLY RECOMMENED!
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of
Relationship
Total Months Lived with you during the tax season?
Are you interested in applying for a cash advance? Up to 7,000?
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Yes (bank fees do apply)
No
E- Signature Below
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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 615-633-6300 or 615-987-2005 or email us info@auniqueexperience.org
Relationship
Total Months Lived with you?
Health Insurance
Please make sure you answer this question to the best of your knowledge to avoid your refund being REJECTED!
Did you receive a Health Insurance Coverage Form (1095A) MARKETPLACE INSURANCE?
*
Yes
No
Other
Back
Next
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Upload your 1098 or closing paperwork if you are a new homeowner.
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Upload form 1098T & School Summary/Syllabus/ Schedule etc.
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Has the student already claimed the AOTC (school credit) on 4 prior tax returns?
Yes
No
Was the student convicted of a felony for possession or distribution of a controlled substance IN 2024?
Yes
No
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