Tax Client Intake
DateTime
Name:
*
First Name
Last Name
Social Security Number:
*
example: 123-45-6789
Date of Birth:
*
Example: 02/01/0123
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email:
*
example@example.com
Phone Number:
*
Please enter a valid phone number.
Referral Name:
example: Big Marco, lady from campbellton rd
Check all that apply...
*
Self-employed
College Student
Totally or Permanently disabled
Employed
Unemployed
Occupation:
*
What is your EIN? (If you do not have one, add your social instead)
*
Example: 56-1307127 or N/A (If it's not applicable)
Did you receive a W-2 or 1099? (If yes, you will be asked to upload your forms below.)
*
Yes
No
Did you receive social security benefits in 2024? (If yes, you will be asked to upload your 1099-SSA below.)
Yes
No
Did you receive unemployment benefits in 2024? (If yes, you will be asked to upload your 1099-G below.)
Yes
No
Were you married as of 12/31/2024 ?
Yes
No
If you have any dependents please list how many?
*
Please Select
0
1
2
3
4
5
6
N/A
Please list dependent information (i.e. Names, Date of Birth, Social Security Number & dependent's relationship to you):
Did the primary taxpayer (or any dependents) receive a Form 1095-A Health Insurance Marketplace Statement?
*
Yes
No
DO YOU RECEIVE AN IP PIN?
*
YES
NO
IF YES, PLEASE PROVIDE IP PIN NUMBER;
Please upload the following files: (License or ID, Social Security Card, W-2 Forms, 1099s or any other dependent documents (if applicable).
*
Browse Files
Drag and drop files here
Choose a file
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of
If using Direct Deposit to receive your Tax Refund, please provide Banking information:
*
Example: Routing # 54637346 , Account # 99876545 or N/A (If it's not applicable) We have cards if you do not have an account.
By Signing, I certify all information is true and correct to the best of my knowledge. Signature:
*
Submit
Submit
Should be Empty: