Client Intake Form

1
Today's Date* This field is required.
Date
Month
Day
Year
2
Your Full Legal Name* This field is required.
First Name
Last Name
3
Your Social Security Number* This field is required.No dashes numbers only
4
Your Date of Birth* This field is required.
Date
Month
Day
Year
5
Current Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
6
Current Home Phone Number
7
Current Cell Phone Number* This field is required.
8
Email Address* This field is required.
example@example.com
9
Current Occupation* This field is required.
10
Have you been a victim of identity theft and been given an identity theft protection PIN by the IRS?* This field is required.
Yes
No
11
If yes, enter the six digit identity protection PIN number
12
Do you have a spouse?* This field is required.
Yes
No
13
Spouse's Full Legal Name* This field is required.
First Name
Last Name
14
Spouse's Social Security Number* This field is required.
15
Spouse's Date of Birth* This field is required.
Date
Month
Day
Year
16
Spouse's Cell Phone Number* This field is required.
17
Spouse's Email Address* This field is required.
example@example.com
18
Your Spouse's Current Occupation* This field is required.
19
Has the spouse been a victim of identity theft and been given an identity theft protection PIN by the IRS?
Yes
No
20
If yes, enter the six digit identity protection PIN number* This field is required.
21
Were you, your spouse, or any of your dependents Enrolled at least part time in an accredited College, Trade School or University in 2023?* This field is required.
Yes
No
22
If Yes, name of accredited College, Trade School or University?* This field is required.
23
How many years of school have been completed prior to December 31, 2023?* This field is required.
24
Were you, your spouse, or any of your dependents who were enrolled at least part time in an accredited College, Trade School or University issued a 1098T or 1098E form?* This field is required.
Yes
No
Not Applicable
25
In which County did you live and work in as of December 31, 2023?* This field is required.
26
In which SCHOOL DISTRICT did you live in as of December 31, 2023?* This field is required.
27
Did you file your 2022 Tax Return ?* This field is required.
Yes
No
28
Did you get a refund or did you owe?* This field is required.
I got a refund
I owe money
I didn't file last year
29
Have you ever had EARNED INCOME CREDIT DISALLOWEDby the IRS?* This field is required.
Yes
No
30
Was your tax return completely offset last year?* This field is required.
Yes
No
31
Will you be filing more than one STATE return? If so, WHICH STATE(S)? Separate them with a ,* This field is required.
32
Are you claiming a dependent that you provided MORE THAN HALF the support for? If so, fill out their information below:* This field is required.
Yes
No
33
Full Legal Name* This field is required.
First Name
Last Name
34
Relationship to Taxpayer* This field is required.
35
Social Security Number* This field is required.
36
Date of Birth* This field is required.
Date
Month
Day
Year
37
Full Legal Name of Biological Mother or Legal Guardian* This field is required.
First Name
Last Name
38
Full Legal Name of Biological Father or Legal Guardian* This field is required.
First Name
Last Name
39
How long did the dependent live in your home during the tax year? In months* This field is required.
40
Did the child reside with one or both parents / legal guardian?* This field is required.
Resided with Mother
Resided with Father
Resided with both
Resided with Legal Guardian
Other
41
If there's a Non-Custodial Parent. Per IRS new guidelines, please indicate where the dependent’s Non-Custodial parent/parents are and why they will not be filing this dependent?* This field is required.
42
Are you claiming another dependent?* This field is required.
Yes
No
43
Full Legal Name* This field is required.
First Name
Last Name
44
Relationship to Taxpayer* This field is required.
45
Social Security Number* This field is required.
46
Date of Birth* This field is required.
Date
Month
Day
Year
47
Full Legal Name of Biological Mother or Legal Guardian* This field is required.
First Name
Last Name
48
Full Legal Name of Biological Father or Legal Guardian* This field is required.
First Name
Last Name
49
How long did the dependent live in your home during the tax year? In months* This field is required.
50
Did the child reside with one or both parents / legal guardian?* This field is required.
Resided with Mother
Resided with Father
Resided with both
Resided with Legal Guardian
Other
51
If there's a Non-Custodial Parent. Per IRS new guidelines, please indicate where the dependent’s Non-Custodial parent/parents are and why they will not be filing this dependent?* This field is required.
52
Are you claiming another dependent?* This field is required.
Yes
No
53
Full Legal Name* This field is required.
First Name
Last Name
54
Relationship to Taxpayer* This field is required.
55
Social Security Number* This field is required.
56
Date of Birth* This field is required.
Date
Month
Day
Year
57
Full Legal Name of Biological Mother or Legal Guardian* This field is required.
First Name
Last Name
58
Full Legal Name of Biological Father or Legal Guardian* This field is required.
First Name
Last Name
59
How long did the dependent live in your home during the tax year? In months* This field is required.
60
Did the child reside with one or both parents / legal guardian?* This field is required.
Resided with Mother
Resided with Father
Resided with both
Resided with Legal Guardian
Other
61
If there's a Non-Custodial Parent. Per IRS new guidelines, please indicate where the dependent’s Non-Custodial parent/parents are and why they will not be filing this dependent?* This field is required.
62
Are you claiming another dependent?* This field is required.
Yes
No
63
Full Legal Name* This field is required.
First Name
Last Name
64
Relationship to Taxpayer* This field is required.
65
Social Security Number* This field is required.
66
Date of Birth* This field is required.
Date
Month
Day
Year
67
Full Legal Name of Biological Mother or Legal Guardian* This field is required.
First Name
Last Name
68
Full Legal Name of Biological Father or Legal Guardian* This field is required.
First Name
Last Name
69
How long did the dependent live in your home during the tax year? In months* This field is required.
70
Did the child reside with one or both parents / legal guardian?* This field is required.
Resided with Mother
Resided with Father
Resided with both
Resided with Legal Guardian
Other
71
If there's a Non-Custodial Parent. Per IRS new guidelines, please indicate where the dependent’s Non-Custodial parent/parents are and why they will not be filing this dependent?* This field is required.
72
Are you claiming another dependent?* This field is required.
Yes
No
73
Full Legal Name* This field is required.
First Name
Last Name
74
Relationship to Taxpayer* This field is required.
75
Social Security Number* This field is required.
76
Date of Birth* This field is required.
Date
Month
Day
Year
77
Full Legal Name of Biological Mother or Legal Guardian* This field is required.
First Name
Last Name
78
Full Legal Name of Biological Father or Legal Guardian* This field is required.
First Name
Last Name
79
How long did the dependent live in your home during the tax year? In months* This field is required.
80
Did the child reside with one or both parents / legal guardian?* This field is required.
Resided with Mother
Resided with Father
Resided with both
Resided with Legal Guardian
Other
81
If there's a Non-Custodial Parent. Per IRS new guidelines, please indicate where the dependent’s Non-Custodial parent/parents are and why they will not be filing this dependent?* This field is required.
82
Are you claiming another dependent?* This field is required.
Yes
No
83
Full Legal Name* This field is required.
First Name
Last Name
84
Relationship to Taxpayer* This field is required.
85
Social Security Number* This field is required.
86
Date of Birth* This field is required.
Date
Month
Day
Year
87
Full Legal Name of Biological Mother or Legal Guardian* This field is required.
First Name
Last Name
88
Full Legal Name of Biological Father or Legal Guardian* This field is required.
First Name
Last Name
89
How long did the dependent live in your home during the tax year? In months* This field is required.
90
Did the child reside with one or both parents / legal guardian?* This field is required.
Resided with Mother
Resided with Father
Resided with both
Resided with Legal Guardian
Other
91
If there's a Non-Custodial Parent. Per IRS new guidelines, please indicate where the dependent’s Non-Custodial parent/parents are and why they will not be filing this dependent?* This field is required.
92
Are you claiming another dependent?* This field is required.
Yes
No
93
Full Legal Name* This field is required.
First Name
Last Name
94
Relationship to Taxpayer* This field is required.
95
Social Security Number* This field is required.
96
Date of Birth* This field is required.
Date
Month
Day
Year
97
Full Legal Name of Biological Mother or Legal Guardian* This field is required.
First Name
Last Name
98
Full Legal Name of Biological Father or Legal Guardian* This field is required.
First Name
Last Name
99
How long did the dependent live in your home during the tax year? In months* This field is required.
100
Did the child reside with one or both parents / legal guardian?* This field is required.
Resided with Mother
Resided with Father
Resided with both
Resided with Legal Guardian
Other
101
If there's a Non-Custodial Parent. Per IRS new guidelines, please indicate where the dependent’s Non-Custodial parent/parents are and why they will not be filing this dependent?* This field is required.
102
Are you claiming another dependent?* This field is required.
Yes
No
103
Full Legal Name* This field is required.
First Name
Last Name
104
Relationship to Taxpayer* This field is required.
105
Social Security Number* This field is required.
106
Date of Birth* This field is required.
Date
Month
Day
Year
107
Full Legal Name of Biological Mother or Legal Guardian* This field is required.
First Name
Last Name
108
Full Legal Name of Biological Father or Legal Guardian* This field is required.
First Name
Last Name
109
How long did the dependent live in your home during the tax year? In months* This field is required.
110
Did the child reside with one or both parents / legal guardian?* This field is required.
Resided with Mother
Resided with Father
Resided with both
Resided with Legal Guardian
Other
111
If there's a Non-Custodial Parent. Per IRS new guidelines, please indicate where the dependent’s Non-Custodial parent/parents are and why they will not be filing this dependent?* This field is required.
112
Will you claim the CHILD CARE DEDUCTION for this tax year?* This field is required.
Yes
No
113
Do you have a signed IRS Form 8332?
Yes
No
Not Applicable
114
Provider Full Legal Name* This field is required.
115
Provider Social Security or EIN* This field is required.
116
Provider Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
117
Provide the child's name and the amount paid per child* This field is required.
118
Do you have any dependents with disabilities?* This field is required.
Yes
No
119
Has any dependent been declared disabled by a physician? If so, can you provide documentation?* This field is required.
120
What is the nature of the disability(ies)?* This field is required.
121
Are you or your spouse listed as the Social Security Representative Payee for the dependent(s)?* This field is required.
122
Is the dependent(s) expected to recover in the next year?* This field is required.
123
Will you claim the DEPENDENT CARE DEDUCTION for the disabled dependent?* This field is required.
124
Did you pay out of pocket for any uncovered Medical Expenses for the disabled dependent* This field is required.
125
Do you receive ANY supplemental, nontaxable income such as child support, Food stamps, Medicaid/ Medicare, TANF, social security, or disability if so, how much? (Please list each type that applies along with the amount)* This field is required.
126
Did you purchase or trade any stocks, options, futures, forex, etc? or any crypto currency (for example: Robinhood, Cashapp, etc?)* This field is required.
127
Did you purchase, trade, or received any crypto, NFT's, airdrops, ? (for example: Bitcoin, Ethereum, BNB, etc?)* This field is required.
128
Do you own Real Estate* This field is required.
Yes
No
129
Did you purchase your first home in 2023?* This field is required.
130
Did you pay real estate taxes in 2023?* This field is required.
131
Did you pay Property Taxes for your home in 2023?* This field is required.
132
Did you pay Mortgage Interest for your home in 2023?* This field is required.
133
Did you make any ENERGY IMPROVEMENTS to your MAIN HOME in 2023?* This field is required.
134
Did you pay upkeep and repair expenses for your home in 2023?* This field is required.
135
Did you pay for Property Insurance for your home in 2023?* This field is required.
136
Did you RENT? IF YES, how many months and the AMOUNT paid in 2023* This field is required.
137
Did you pay renters insurance?* This field is required.
138
Did you purchase a NEW VEHICLE after February 16, 2023?* This field is required.
139
Do you have personal property taxes:* This field is required.
140
Amount of any significant MEDICAL/DENTAL expenses* This field is required.
141
Amount of any cash-noncash contributions to charity in 2022* This field is required.
142
Todays Date* This field is required.
Date
Month
Day
Year
143
Upload a VOIDED check for Direct Deposit
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
144
Name of Bank* This field is required.
145
Routing Number* This field is required.
146
We continue to grow our business through loyal customers like you. Please look in your cell phones and provide us with at least 3 names and phone numbers of people needing assistance in preparing their taxes and getting back the maximum amount of money they are legally entitled as such it is imperative to us that you leave at least 1 referral: Phone Number Name
147
Name
148
Phone Number
149
Name
150
Phone Number
151
Name
152
Phone Number
153
Signature* This field is required.
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