U First Income Tax Preparation Client Intake Form

Tax Preparation Client Intake Form

To better service you. Please complete form.
U First Income Tax & Business Solutions

1264 S Waterman Ave. Ste 18. San Bernardino, CA 92408

Office: 909-893-0424 Email: ufirstincometax@gmail.com
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower
Which Tax year are you filing?*

20222021Other
Are you a new or returning client?*

I'm New!I'm Returning!
Where you referred? who referred you?
Are you Applying for In-Season Tax Advance Loan?*

Do you want to apply for the No Cost to you Advance? $250, $500. $1000*Do you want to apply for Tax Advance Loan great than $1000* Subject to 36%APR*No thanks, I can wait
Primary Email*
example@example.com

Spouse Information (only if filing Married Filing Jointly)
Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Taxpayer Occupation Title:
SSN
Are you a full-time student?

YesNo
Are you totally and permanently disabled?

YesNo
Are you legally blind?

YesNo
Is this individual dependent of other?*

YesNo
Did you receive a federal tax refund last year?

YesNo
Do you owe any agency? IRS, Franchise Tax Board, City, County, Child Support?*

YesNo

How much do you owe?

Enter your dependents here

Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?

Documents I am including (For Self and Dependents):*

	Provided
ID*
Social Security Cards*
Birth Certificates*
School Records*
W2
IP PIN Letter
1099- Misc
1099- NEC
1095-A (Healthcare Ins./ Marketplace)*
1095-B /C (Healthcare Ins.)*
1098- (Mortgage)
1098-T (Education)
1099-G (Unemployment)
1099-R (Pension/IRA/Annuity Income)
1099- B/S (Sales of Stock or Other Property)
1099-SA (Health Savings Account)
Form 8332 (Child Custodial Parent Release
Form 6419 (Child Tax Credit Letter)
Child Care Provider Info (Babysitter)
Self Employed Income and Expense

Upload Document Here

Upload at least 1 document; ID, Social Cards, Medical 1095's, w2's
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Upload Additional Documents

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As a measure to protect your Identity through our virtual tax preparation, we ask you to take a photo of yourself as validation for ID proofing: *

Acknowledgment & Signature
- I confirmed that all information I entered here is accurate and true.
- I allow U First Income Tax & Business Solutions to capture my sensitive data like personal id, government id, social security number (SSN), and other information.
- I have read the terms and conditions and privacy policy of U First Income Tax & Business Solutions.
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*

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Date Signed

MonthDayYear
Date
Spouse Signature

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Business Information

Only fill out this form if applicable
Business Name /DBA
EIN Number:
What is your Business Structure?

Sole ProprietorSingle-Member LLCMulti-Member LLC/ PartnershipS-Corporation/ C-Corporation

Business Expenses

File Upload- Upload Articles of Incorporation/ EIN Letter/ Additional Documentation

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Tax Preparation Client Intake Form