A Unique Intake Form 2026

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 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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EARNED INCOME TAX CREDIT (EITC)

DUE DILIGENCE DISCLOSURE & TAXPAYER CERTIFICATION

A Unique Experience

SECTION 1: EITC ELIGIBILITY ACKNOWLEDGMENT
(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

SECTION 2: QUALIFYING CHILD & HOUSEHOLD CERTIFICATION
(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.

SECTION 3: MAXIMUM CREDIT DISCLOSURE (NOT GUARANTEED)
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.

SECTION 4: REFUND TIMING NOTICE (PATH ACT)
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.

SECTION 5: TAXPAYER PENALTY & PERJURY DISCLOSURE
(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

SECTION 6: PREPARER DUE DILIGENCE DISCLAIMER
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.

SECTION 7: TAXPAYER CERTIFICATION & SIGNATURE
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.

Signature
Taxpayer Name*
Signature*

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Date*

MonthDayYear
Date

Who is your tax professional ?*
Are you a new client?*

YesNo, returning client
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?*

YesNo
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*

2025 Current Year2024 Last Year20232022
Name*

First NameMiddle NameLast NameSuffix

Social Security Number*
Phone Number*

Area CodePhone Number
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?*

FederalStateBOTH
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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Were you married in 2025?*
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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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 BillLease or Mortgage
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?

yesno
Cash Advance up to $7500 interest loan (fees apply)*

YesNo
Select below the method that you prefer to receive your refund*

Direct DepositCheck
Account Type*

CheckingSavings
PLEASE UPLOAD DRIVERS LICENSE*

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Bank Name:*
CURRENT MAILING ADDRESS*

Street Address

Street Address Line 2

CityState

Zip Code
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
Date Of Birth*

MonthDayYear
Date
Social Security Number*
First Name*
Middle Name
Date Of Birth

MonthDayYear
Date
File Upload

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2. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Date Of Birth

MonthDayYear
Date
3. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Social Security Number
Date Of Birth

MonthDayYear
Date
4. Dependent Information

GenderFirst NameMiddle NameLast NameSuffix
Date Of Birth

MonthDayYear
Date
Social Security Number
Do you want to enter another dependent?

YesNo, all dependents are entered
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?*

YesNo
Did you or your dependents attend a College or university or took post secondary education classes last year?*

YesNo
Spouse Information
Spouse Name*

First NameMiddle NameLast NameSuffix
Date of Birth*

MonthDayYear
Date
Social Security Number*
Occupation*
Phone Number*
Email*
example@example.com
Relationship *
Are any of your children disabled?*

YesNo
Total Months Lived with you during the tax season?? *
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*

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

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