Client Tax Intake Form

Thank you for taking time to complete your 2025 Client Intake Form. For new clients, this information is critical to ensure we accurately file your tax return. For existing clients, we kindly request that you provide this information again to ensure our records are 100% accurate & up to date. Please Allow up to 7 Business Days (due to peak season) from date of submission, giving we have all documents to complete your tax file.

How did you hear about us?

FacebookInstagramReferralPrevious Client

What tax year are you filing?

Tax Preparer Name

If someone referred you, please type his or her name here.

Are you trying to buy a new home within the next 2 years?

YesNo

Are you interested in Credit Repair?

YesNo

Tax Payers Name

First NameLast Name

Taxpayer's Phone Number*

Example: xxx-xxx-xxxx

Taxpayer's Job Title

Taxpayer's Date of Birth*

Example: 01/01/2001

Taxpayer's SSN

Example: xxx-xx-xxxx

Taxpayer's Email Address*

Spouse Name

First NameLast Name

Spouse's SSN

Example: xxx-xx-xxxx

Occupation:

EmployedSelf employedStudentNot employed

Spouse's Date of Birth

Example: 01/01/2001

Spouse's Phone Number

Example: xxx-xxx-xxxx

Spouse's Email Address

Example: example@example.com

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What county do you reside in?

Are you self employed?*

YesNo

Did you and your spouse live apart during the year?*

YesNoNot Applicable

What is your marital status as of December*

Single (Not Married)Married living with SpouseMarried not living with spouseQualifying Widower

What was your filing status last year?

SingleMarried filing jointlyMarried filing separatelyQualifying Widower

Did you pay over half the expenses of maintaining your residence for the entire year?*

YesNo

Did you support a child or family member for more than 6 months out of the year?*

YesNo

If yes, did you live together at any time after June 30, 2025?*

YesNoNot Applicable

How many dependents are you claiming?*

Dependent #1

First NameLast Name

Dependent #1 Date of Birth

01/01/2001

Dependent #1 SSN

What is Dependent #1's Relationship to you (son, daughter, etc.)?

How many months did Dependent #1 live with you in 2025? (If all year, enter 12)

Dependent #2

First NameLast Name

Dependent #2 Date of Birth

Example: 01/01/2001

Dependent #2 SSN

How many months did Dependent #2 live with you in 2025? (If all year, enter 12)

What is Dependent #2's Relationship to you (son, daughter, etc.)?

Dependent #3

First NameLast Name

Dependent #3's Date of Birth

01/01/2001

How many months did Dependent #3 live with you in 2025? (If all year, enter 12)

Dependent #3s SSN

Example: xxx-xx-xxxx

Dependent's #3 SSN

What is Dependent #3's Relationship to you (son, daughter, etc.)?

Dependent #4's First Name

First Name

Dependent #4's Last Name

Last Name

Dependent #4's Date of Birth

01/01/2001

Dependent #4's SSN

Example: xxx-xx-xxxx

What is Dependent #4's Relationship to you (son, daughter, etc.)?

How many months did Dependent #4 live with you in 2025? (If all year, enter 12)

Dependent #5's First Name

First Name

Dependent #5's Last Name

Last Name

Dependent #5's Date of Birth

01/01/2001

Dependent #5's SSN

Example: xxx-xx-xxxx

What is Dependent #5's Relationship to you (son, daughter, etc.)?

How many months did Dependent #5 live with you in 2024? (If all year, enter 12)

Are there any dependents in daycare? If yes, please upload the form you received from your daycare provider.

YesNo

Do you have income? If so, what type of income do you have? (Ex. W2, 1099, Business Owner)

Do you owe student loans, government agency, taxes or child support? Please call the Debt Offset Hotline at 1-800-304-3107 to confirm your government debt agency and amount prior to consultation?

Are you interested in applying for a cash advance?

YesNo

How would you like to receive your tax refund?*

Check (Only available for in office visits)Direct DepositPrepaid Debit Card

Name of Bank*

Which type of account would you like your refund deposited into?*

Checking AccountSavings AccountOther

Routing Number *

Bank Account Number *

Confirm Bank Account Number*

Can someone else claim you as a dependent?

YesNo

Did you have health insurance in 2025?

YesNo

Did you have health insurance for the entire year?*

YesNo

Who was your insurance cover through in 2024?

Was your insurance through your employer?

YesNo

Was your insurance through Medicaid?

YesNo

Was your insurance through the Affordable Care Act (The Marketplace)?

YesNo

Did your dependents have health insurance for the entire year?

YesNoNot Appliable

Was YOUR DEPENDENTS' insurance through your employer?

YesNoNot Applicable

Was YOUR DEPENDENTS' insurance through Medicaid?

YesNoNot Applicable

Was YOUR DEPENDENTS' insurance through the Affordable Care Act (The Marketplace)?

YesNoNot Applicable

Have you ever been denied the Earned Tax Credit (EITC)?

YesNo

Did you trade any Virtual Currency

YesNo

Were you or any of your dependents in college in 2024?

YesNo

Do you have a 1098-T Form for either you or your dependents?

YesNo

Are you interested in AUDIT PROTECTION?

YesNo

Did you receive a Identitiy Protection Pin (IP PIN) letter from the IRS?

ADDITIONAL SERVICES At Campbell's Elite Tax Services LLC, we do more than just taxes. Please check below if you would be interested in any of the additional services we provide. We will schedule a time to speak with you ar a later time.

Are you in need of any of the additional services?

Were you referred to our office? If so please include the first and last name of the person who referred you to us.

YesNoOther

Primary Taxpayer's Signature

Date

Taxpayer's Signature (If no spouse, leave blank)

Spouse's Signature (If no spouse, leave blank)

Date

CLIENT NON PAYMENT/OFFSET CLAUSE at ELITE PRO CONSULTING FIRM LLC, we strive to assist all of our clients in their tax needs, however we understand that situations arise. If your refund is offset by the IRS, student loans, child support or you refuse to have your return filed with the preparer for ANY reason after the return has been worked on, you are still obligated to pay our company the fees associated with filing your tax return. By signing this agreement you acknowledge that if payment is not made in full with in 30 days the full payment will be auto drafted using CPA Charge from the bank account on the client intake form completed and submitted. If for ANY reason the funds cannot be auto drafted you understand by signing this form that legal actions will be sought to resolve payment.

I am giving ELITE PRO CONSULTING FIRM LLC permission to prepare all forms related to my tax return; to apply for and secure RAC's and RAL's on my behalf; and sign all necessary forms and file my taxes electronically. I take full responsibility for the accuracy of this form and understand that Campbell's Elite Tax Services LLC and/or associated affiliates hold no responsibility for any misrepresentation or false claims.

This form is secure and your answers will be encrypted.
Thank you for Choosing Elite Pro Consulting Firm this tax season.

IMPORTANT INFORMATION: UPON COMPLETION OF ALL APPLICABLE PARTS OF THIS FORM YOU MUST CLICK THE "SUBMIT" BUTTON AT THE BOTTOM OF THE FORM TO SEND THIS INFO TO OUR OFFICE. CLOSING YOUR BROWSER BEFORE CLICKING THE "SUBMIT" BUTTON WILL DELETE ALL INFO WITHOUT SENDING TO US, UNLESS YOU CLICK THE "SAVE" BUTTON FIRST! IT SHOULD BE NOTED THAT UPON CLICKING THE "SUBMIT" BUTTON, YOU WILL GET A CONFIRMATION EMAIL THAT WE RECEIVED YOUR INFO AND SOMEONE WILL FOLLOW UP WITH YOU IN 24-48 HOURS. IT SHOULD ALSO BE NOTED THAT UPON CLICKING THE "SAVE" BUTTON, YOU WILL GET A CONFIRMATION EMAIL WITH A LINK TO PICK UP WHERE YOU ORIGINALLY LEFT OFF.

Please also note that to comply with federal and state identity theft protection efforts our firm will ask for a valid state issued photo identification card during your engagement.

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This questionnaire may take you up to 20 minutes to complete. Please be sure to organize all of your tax documents prior to completing the form.

CLIENT FORM