A Unique Intake Form 2026

2025 Client Intake Form
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
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 mailed out to you, 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?

EARNED INCOME TAX CREDIT (EITC)

DUE DILIGENCE DISCLOSURE & TAXPAYER CERTIFICATION

A Unique Experience
- (Required for All Taxpayers Claiming EITC)
  
  I understand that to claim the Earned Income Tax Credit (EITC), I must meet all IRS eligibility requirements, including but not limited to the following:
  
  Adjusted Gross Income (AGI) Limits for Tax Year 2025
  My AGI must be less than:
  • $61,555 ($68,675 MFJ) with three or more qualifying children
  • $57,310 ($64,430 MFJ) with two qualifying children
  • $50,434 ($57,554 MFJ) with one qualifying child
  • $19,104 ($26,214 MFJ) with no qualifying children
  
  I further acknowledge that I must meet all of the following conditions:
  • I have a valid Social Security Number issued before the due date of the return
  • I am not filing as Married Filing Separately
  • I was a U.S. citizen or resident alien for the entire tax year
  • I did not file Form 2555 or Form 2555-EZ
  • My investment income does not exceed $10,300
  • I earned at least $1 of earned income
  • Any qualifying child meets the IRS relationship, age, residency, and joint return tests
  • No other taxpayer is claiming the same qualifying child
  • I am not the qualifying child of another taxpayer
  • If claiming EITC without a qualifying child, I am at least 25 and under age 65
  • I am not claimed as a dependent by another taxpayer
  • I lived in the United States for more than half of the year
- (Due Diligence Verification Statement)
  
  I certify that the qualifying child(ren) listed on my return:
  • Lived with me in the United States for more than half of the tax year
  • Were financially supported primarily by me
  • Are not being claimed by any other taxpayer for EITC, CTC, ACTC, or HOH filing status
  
  I understand that providing false information regarding dependents or residency may result in the denial of credits, repayment of refunds, penalties, and a multi-year ban from claiming EITC.
- I understand that the maximum EITC amounts for Tax Year 2025 are:
  • $8,046 – Three or more qualifying children
  • $7,152 – Two qualifying children
  • $4,328 – One qualifying child
  • $649 – No qualifying children
  
  I acknowledge that eligibility does not guarantee receipt of the maximum credit, and final credit amounts are determined by IRS calculations based on verified income, filing status, and household information.
- I understand that if I claim the Earned Income Tax Credit (EITC) or Additional Child Tax Credit (ACTC), the IRS is legally prohibited from issuing my refund before mid-February, even for portions of the refund not related to these credits.
- (Required for Due Diligence Compliance)
  
  I acknowledge that all information provided is true, correct, and complete to the best of my knowledge. I understand that intentionally providing false or misleading information may subject me to:
  • Repayment of refunds
  • Accuracy-related penalties
  • Civil fines
  • Criminal penalties for tax fraud or perjury
  • Disallowance of EITC for up to 10 years
- A Unique Experience Compliance Statement
  
  A Unique Experience prepares tax returns based solely on information provided by the taxpayer. We are required by law to ask questions, document responses, and request reasonable explanations when information appears inconsistent.
  
  We do not audit, investigate, or independently verify documents unless required by IRS due diligence standards. The taxpayer remains fully responsible for the accuracy of all information reported on the tax return.
- I certify that I have reviewed this document, understand the Earned Income Tax Credit rules, and affirm that all information provided to A Unique Experience is accurate and complete. I understand that this certification may be retained with my tax records and provided to the IRS if requested.
- FULL NAME
- YOUR SIGNATURE
- Date
  
  MonthDayYear
  Date

Who is your tax professional?
Are you a new client?
If you did not file your tax return with us last year, please upload a copy of your previous year's tax return

HIGHLY RECOMMENED!
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If New, who Referred You to the company?
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.
Please Upload A Selfie

.
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Tax Year

Please Enter Your Social
Please Enter your Date of Birth
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
PLEASE UPLOAD DRIVERS LICENSE

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UPLOAD YOUR SS CARD OR BC

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Occupation: example: Cashier, truck driver, self employed,assembler etc.
what is your job title?
Email
example@example.com
Do you have a dependent or dependents you are claiming this year?
Are You Filing a Federal or State Tax Return?
Do you have an Identity Protection Pin issued by the IRS?
If yes, please upload your IP Pin from the IRS here.

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Were you married in 2025?
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.
File Upload

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CURRENT MAILING ADDRESS

Street Address

Street Address Line 2

CityState

Zip Code
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.
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

How Would You Like to Receive Your Refund?
Are you interested in applying for an interest free loan up to $1,000?
Cash Advance up to $7500 interest loan (fees apply)
Select below the method that you prefer to receive your refund
Account Type
Bank Name:
Bank Account Number:
Bank Routing Number

Dependents

MUST SHOW PROOF! Birth certificate, social security card, leasing agreement, report card & shot records!
Did you receive child support, or did you pay child support in 2025? If so, how much did you receive? Example: I received 1200 in childsupport for 3 kids for 12 months
Image of All Dependent's S.S.Card

Upload ALL here
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1. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Relationship
Date Of Birth

MonthDayYear
Date
Social Security Number
2. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Relationship
Date Of Birth

MonthDayYear
Date
SOCIAL SECURITY NUMBER
3. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Relationship
Date Of Birth

MonthDayYear
Date
Social Security Number
4. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Relationship
Social Security Number
Date Of Birth

MonthDayYear
Date
Are any of your children disabled?
Total Months Lived with you during the tax season??
Do you want to enter another dependent?
Other Dependents
Upload photos of your W2,1099, & 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.
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?
Did you or your dependents attend a College or university or took post secondary education classes last year?
Spouse Information
Spouse Name

First NameMiddle NameLast NameSuffix
Date of Birth

MonthDayYear
Date
Social Security Number
Occupation
Phone Number
Format: (000) 000-0000.
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

SIGN YOUR NAME HERE

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 email us at support@auniqueexperience.online
Should be Empty:

2025 Client Intake Form

How Would You Like to Receive Your Refund?

Dependents

Upload photos of your W2,1099, & ALL Income documents

Spouse Information

Market Place Insurance?

Schedule C - Business Owner Information

Business Details

Income Information