Phoenix Tax Services LLC Client Intake Form

Phoenix Tax Services LLC Client Intake Form
Thank You for taking the time to complete your Client Intake Form. This information is critical to ensure your tax return is filed accurately. Please take your time and review all information before you submit. Please note that if documents are missing or information is incorrect this will result in a delay in processing your return.

This intake form will take 20- 30 minutes to complete.

Please complete this form in its ENTIRETY and click SUBMIT when finished. Upload all documents at the end of the form.

Please wait until you have ALL of your documents before submitting this form.

Note: If you are claiming any dependents, be sure to upload their SS CARDS, BIRTH CERTIFICATES, and all items that show their address is the same as yours. (e.g. school records, medical records, doctor bills, Medicaid Statement, Social Services Records, or anything that shows your child's name and current address).

PLEASE READ THROUGH ITS ENTIREITY.

DO NOT SUBMIT THIS FORM UNTIL YOU HAVE ALL SUPPORTING DOCUMENTS.

BY NOT FOLLOWING DIRECTIONS YOUR INTAKE FORM WILL NOT BE PROCESSED.

BE SURE ALL SUPPORTING DOCUMENTS ARE VALID & CURRENT.

BE SURE LEASE AND OTHER SUPPORTING FORMS HAVE THE DEPENDENTS NAME ON THEM IF APPLICABLE.
How did you hear about us?
Which Tax Year are you filing for?
Will this be an amended (corrected) return?
Are you interested in applying for an advance loan?

If you are filing multiple years you must complete a separate form for each year
GENERAL INFORMATION
Appointment
Date Of Interview

MonthDayYear
Date
Interviewing Settings
Taxpayer's Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer's Proof of Residency (Ex Lease,Utility Bill,Etc

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Taxpayer's Social Security Number
Taxpayer's Date Of Birth

MonthDayYear
Date
Taxpayer's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Taxpayer's Email Address
example@example.com
Taxpayer's Occupation
What is your marital status as of December 31st?
Taxpayer's Driver's License/ State ID (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Please upload a Selfie to Validate your Government Issued ID.

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Taxpayer's Social Security Card (Stand directly over the item on a flat surface and zoom in for a clear shot)

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Were you previously issues an Identity Protection Pin (IPPIN) by the IRS?
IP PIN IDENTITY THEFT IF (APPLICABLE) (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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Can someone else claim you as a dependent?
Do you owe the IRS, Child Support or in default with student loans?
Have you ever been disallowed for EITC/AOTC/CTC/ACTC?
Are you self employed?
Did you buy or trade Crypto Currency? (Bitcoin)
Do you have gambling winnings for the year?
Did you make any charitable contributions during the year?
Did you withdraw from your 401K during the year ?

SPOUSE INFORMATION
Spouse's Name

First NameLast Name
Spouse's Date of Birth

MonthDayYear
Spouse's Social Security Number
Please upload a Selfie of your spouse to validate their Government Issued ID.

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What type of income documents will you be submitting? (For Self Employment a separate Intake Form & Ledger are required.)
Upload W2 statements (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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1099 NEC (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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Did you receive unemployment during the year?
Upload other Misc. Income Documents such as 1099 INT, 1099 DIV, 1099 NEC. (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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CURRENT LIVING SITUATION
Do you receive Subsidized Housing or Section 8?
Do you receive any Government Assistance Programs such as Food stamps, TANF, Medicaid, or Medicare in during the year?
Do you have a 1098 Mortgage Interest Statement?
Was your insurance through the Affordable Care Act (The Marketplace)?
Did anyone in your household attend college for the selected tax year?
What was the Name of the person who attended college?

DEPENDENT'S INFORMATION
Are you claiming any dependents on your tax return?
How many dependents are you claiming?
Dependent's Name #1

First NameLast Name
Dependent's Date Of Birth

MonthDayYear
Date
Dependent's Social Security Number
Please upload a Social Security Card for Dependent

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Dependent's Relationship
Dependent's Name #2

First NameLast Name
Dependent's Date Of Birth

MonthDayYear
Date
Dependent's #2 Social Security Number
Please upload a Social Security Card for Dependent #2

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Dependent's Relationship
Dependent Name #3

First NameLast Name
Dependent's Date Of Birth

MonthDayYear
Date
Dependent's Social Security Number
Please upload a Social Security Card for Dependent #3

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Dependant's Relationship
(8812 CTC) Did you receive monthly IRS Advance Tax Credit payments?
Please Upload IRS Forms 6419 Advanced Child Tax Credit Payment Received for Children (Stand directly over the item on a flat surface and zoom in for a clear shot.)

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ACKNOWLEDGEMENT & SIGNATURE
Are you interested in Advance Loan?
Are you interested in Audit Protection? (Recommended For ALL Schedule C'S)
STOP!

Did you finish uploading your documents?IF YOU DID NOT UPLOAD ALL NECESSARY DOCUMENTS YOUR INTAKE FORM WILL BE VOIDED.
How would you like you refund disbursed if receiving on?
CLIENT NON-PAYMENT/OFFSET CLAUSE

At Phoenix Tax & Services 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 your check is mailed, 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 within 30 days legal actions will be sought to resolve payment.
Name Of Bank
Routing Number
Bank Account Number
Primary Taxpayer's Signature
I am giving Phoenix Tax Services LLC permission to prepare all forms related to my tax return. To apply for and secure RAC's and RAL's on my behalf, sign all necessary forms and file my taxes electronically. I take full responsibility for the accuracy of this form and understand that Phoenix Tax Services and/or associated affiliates hold no responsibility for any misrepresentation or false claims.
Gender
Date of Birth

MonthDayYear
Date Signed

MonthDayYear
Taxpayer's Signature
Should be Empty: