TAX CLIENT INTAKE FORM

CLIENT INTAKE FORM

Kindly Fill This Form Out So We Can Assist You Better
How did you hear about us?

FacebookInstagramReferralPrevious Client
Tax Preparer Name
If someone referred you, please type his or her name here.
Are you looking to purchase a new home within the next 2 years?

YesNo
Taxpayer Name

First NameLast Name
Taxpayer Phone Number
Please enter a valid phone number.
Taxpayer Job Title
Taxpayer Date of Birth*

MonthDayYear
Example: 01/01/2001
Taxpayer SSN
Example: xxx-xx-xxxx
Taxpayer Email Address
example@example.com
Home Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Spouse Full Name

First NameLast Name
Spouse Date of Birth*

MonthDayYear
Example: 01/01/2001
Spouse SSN
Example: xxx-xx-xxxx
Spouse Phone Number
Please enter a valid phone number.
Spouse Email Address
example@example.com
Taxpayer SSN
Example: xxx-xxx-xxxx
Spouse Job Title
What is your marital status as of December 2025

Single (never married)MarriedMarried not living with spouse
Are you self-employed?

YesNo
Are you a household employee?

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

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

YesNo
Did you support a child(ren) 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, 2024?

YesNoNot Applicable
Are you on any Government Assistance

YesNoNot Applicable
How many dependents are you claiming?
Dependent #1

First NameLast Name
Dependent #1 Date of Birth

MonthDayYear
Date
Dependent #1 SSN
What is dependent #1 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

MonthDayYear
Date
Dependent #2 SSN
How many months did dependent #2 live with you in 2025? (If all year, enter 12)
What is dependent #2 relationship to you (son, daughter, etc.)?
Dependent #3

First NameLast Name
Dependent #3 Date of Birth

MonthDayYear
Date
How many months did dependent #3 live with you in 2025? (If all year, enter 12)
Dependent #3 SSN
What is Dependent #3 Relationship to you (son, daughter, etc.)?
Dependent #4

First NameLast Name
Dependent #4 Date of Birth

MonthDayYear
Date
Dependent #4 SSN
What is dependent #4 relationship to you (son, daughter, etc.)?
How many months did dependent #4 live with you in 2024? (If all year, enter 12)
Dependent #5

First NameLast Name
Dependent #5 Date of Birth

MonthDayYear
Date
Dependent #5 SSN
What is Dependent #5 relationship to you (son, daughter, etc.)?
How many months did Dependent #5 live with you in 2025? (If all year, enter 12)
Did you pay a daycare provider or an individual to care for your dependent(s) while you worked, looked for employment or attended school in 2025? If yes, please upload the form or letter you received.

YesNo
How would you like to receive your tax refund?

ChecksDirect DepositFasterMoney Visa Card
Name of Bank
Which type of account would you like your refund deposited into?

Checking AccountSavings AccountOther
Routing Number
Bank Account Number
Can someone else claim you or your dependent(s) as a dependent on their tax return?

YesNo
Did you, your spouse, or dependent(s) have health insurance under the Affordable Care Act, also known as Obama Care, Healthcare.gov, or Marketplace in 2025?

YesNo
Who was your insurance coverage through in 2025?
Was your insurance through your employer?

YesNo
Was YOUR DEPENDENTS' insurance through your employer?

YesNo
Who was your Dependents insured with in 2023?
Upload Taxpayer & Dependent(s)Insurance Documents

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

YesNo
Were you or any of your dependents in college in 2023?

YesNo
Did you trade any Virtual Currency

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

YesNo
If you have a 1098-T form, upload it here.

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Are you interested in AUDIT PROTECTION?

YesNo
Primary Taxpayer's Signature

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Date

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

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

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Date

MonthDayYear
Date
Type a question
Taxpayer's Driver's License

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Taxpayer's and Dependent(s ) Social Security Card(s)

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Taxpayer's W-2/ 1099'S

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Dependent(s) Birth Certificate(s)

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Dependent(s) Proof of Residency (Lease/Utility Bill)

Cancelof
Should be Empty: