Client Intake Form

Get The MAXX With Unique Tax

To file your federal and state tax returns, we require the following information. Please rest assured that the details you provide will remain strictly confidential. We deeply value your trust as our client and guarantee that your information will not be shared with any third-party entities, except the bank involved in providing advance loans and processing bank applications.
Are You A New Client Or Returning Client?*

New ClientReturning Client
Please Select Your Filing Status Below:*

SingleHOHMFJMFSWidower
Who Is Your Preparer?
Would you like to request a Refund Advance Loan? (additional fees apply)*

YesNo
Do You Have An IP PIN?*

YesNo
What Is Your IP Pin Number?
If someone referred you, please type his or her name here
TAXPAYER INFORMATION
Tax Payer's Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Taxpayer's Date of Birth*
Taxpayer's SSN*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you own or rent?*

RentOwn
How much is your rent/mortgage? *
Are Claiming Any Dependents?*

YesNo
Did anyone else live with you other than your dependent(s) in the tax year? (Determine if anyone else can claim dependent)?*

YesNo
"If Yes, please indicate the person(s) living in the household: *
Have you ever been disallowed the EITC, AOTC, or CTC?*

YesNo
"If Yes, please indicate the which it was for *
Are you claiming a niece, nephew, grandchild, or other relative instead of your own children, and you are providing 50% or more of their expenses?*

YesNo
Did the child pay over 50% of his/her own support during the year, such as food, rent, etc.?*

YesNo
Can you provide documents showing that the child lived with you for more than half of the year?*

YesNo
If you're the only parent claiming the child, why is the other parent not claiming them? *
Did you receive any type of supplemental income such as child support, welfare, food stamps or social security, etc.?*

Child SupportWelfareFood StampSocial SecurityNone Of The Above

Why do you and your child have different last names? (If Applicable If Not Put NA)*
INCOME
Please select all forms of Income*

W21099 NECSELF EMPLOYED1099R1099-SSA
Health Insurance Questionnaire
Did you have health insurance coverage at any time during the 2024 tax year?*

Yes, for the full yearPenalty on Withdraw of SavingSELF EMPLOYEDNo
What type of coverage did you have?*

Employer-sponsoredMarketplace/ACA PlanMedicaid/MedicareOther
Earned Income Credit

Additional Due Diligence
Areas of Emphasis

Around 60% of all mistakes in EITC are the results of 3 main areas:

1. Claiming a Child Who Does Not Qualify:

Errors often arise in determining whether a child meets the eligibility criteria for EITC. The child must pass all qualifying tests: relationship, age, residency, and joint return

2. Filing Status Errors:

Incorrectly claiming a filing status, such as Head of Household or Married Filing Jointly, is a common mistake.

3. Income Reporting Errors:

Misreporting earned income or incorrectly calculating self-employment income impacts the credit amount.

The people who are eligible for EITC:

1. Have earned income
2. Have a valid Social Security Number
3. Must file as Single, Married Filing Jointly, Head of Household, or Qualifying Widow(er)
4. Must be a U.S. citizen or resident alien for the entire year
5. Are not a qualifying child of another person
6. Investment income must be $11,000 or less for the tax year
UNEMPLOYMENT BENIFITS

Please have accurate amount to prevent IRS Delay for your refund
Did you receive Unemployment Benifits?*

YesNo
If so, please specify the amount and attach the 1099-G form.
Please attach the 1099-G form.

Cancelof
BUSINESS INFORMATION.

Please provide an EIN, a business card, LLC Form, or Cash App statements
Are you self employed? (1099 independent Contractor Uber, Lyft, etc)*

YesNo
Name of Business*
EIN Number*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
When did your business start? Can you specify the month and year? *
Do you have a Business license? *
Do you have employees or contractors?*
How do you keep your business records?*
How Did you calculate your income? *
Do you have business expenses? *
Schedule C - Business Expenses

Please provide an EIN, a business card, LLC Form, or Cash App statements

Taxpayer's ID and/or Driver's License*

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

Cancelof
Taxpayer's W-2/ 1099'S/*

Cancelof
Dependent(s) Birth Certificate(s)*

Cancelof
Proof of Residency (Lease Agreement or/Utility Bill) if you are filing (Head of Household)

Cancelof
Payment of Tax Refund Disbursement
How would you like to receive your tax refund?

CheckDeduct From Refund (Refund Transfer or Bank Produc (Direct Deposit)tPrepaid Greendot Card (The card will be provided to you)Pay Upfront: Cash, Debit Card, Credit Card Payment
Name of Bank (ONLY IF YOU ARE DOING DIRECT DEPOSIT)
Which type of account would you like your refund deposited into?

Checking AccountSavings Account
Routing Number
Account Number
Taxpayer Signature*

Clear
Spouse Signature

Clear
Date*

MonthDayYear
Date
Date

MonthDayYear
Date
Should be Empty:

	Amount $
Advertising
Travel
Rent/Lease
Meals
Supplies
Office Expense
Depletion
Contractor Labor
Insurance (other than health)
Commission and fees
Rent or lease of equipment
Rent or lease of property
Taxes and licenses
Meals (50%) Enter 100% of the expenses.
Meals (80%) Enter 100% of the expenses.
Utilities

	Name	Social Security	IP PIN	Date of Birth	Relationship
1
2
3
4

Get The MAXX With Unique Tax

TAXPAYER INFORMATION

INCOME

Health Insurance Questionnaire

Earned Income Credit

UNEMPLOYMENT BENIFITS

BUSINESS INFORMATION.

Schedule C - Business Expenses

Payment of Tax Refund Disbursement