Client Intake Form

1
Image Field
2
Are You A New Client Or Returning Client?* This field is required.
New Client
Returning Client
3
Who Is Your Preparer?* This field is required.
Please Select
Please Select
Tamika
4
Would you like to request a Refund Advance Loan? (additional fees apply)* This field is required.
Yes
No
5
Do You Have An IP PIN?* This field is required.
Yes
No
6
What Is Your IP Pin Number?
7
If someone referred you, please type his or her name here
8
Tax Payer's Name* This field is required.
First Name
Last Name
9
Phone Number* This field is required.
Please enter a valid phone number.
10
Email* This field is required.
example@example.com
11
Taxpayer's Date of Birth* This field is required.
12
Taxpayer's SSN* This field is required.
13
Home 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
14
Do you own or rent?* This field is required.
Rent
Own
15
How much is your rent/mortgage?* This field is required.
16
Are Claiming Any Dependents?* This field is required.
Yes
No
17
Did anyone else live with you other than your dependent(s) in the tax year? (Determine if anyone else can claim dependent)?* This field is required.
Yes
No
18
"If Yes, please indicate the person(s) living in the household: * This field is required.
19
Have you ever been disallowed the EITC, AOTC, or CTC?* This field is required.
Yes
No
20
"If Yes, please indicate the which it was for * This field is required.
21
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?* This field is required.
Yes
No
22
Did the child pay over 50% of his/her own support during the year, such as food, rent, etc.?* This field is required.
Yes
No
23
Can you provide documents showing that the child lived with you for more than half of the year?* This field is required.
Yes
No
24
If you're the only parent claiming the child, why is the other parent not claiming them? * This field is required.
25
Did you receive any type of supplemental income such as child support, welfare, food stamps or social security, etc.?* This field is required.
Child Support
Welfare
Food Stamp
Social Security
None Of The Above
26
If You Are Claiming Dependents Please Enter Their Info Below* This field is required.
Name
Social Security
IP PIN
Date of Birth
Relationship
1
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
2
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
3
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
1
2
3
4
Name
Row 0, Column 0
Social Security
Row 0, Column 1
IP PIN
Row 0, Column 2
Date of Birth
Row 0, Column 3
Relationship
Row 0, Column 4
Name
Row 1, Column 0
Social Security
Row 1, Column 1
IP PIN
Row 1, Column 2
Date of Birth
Row 1, Column 3
Relationship
Row 1, Column 4
Name
Row 2, Column 0
Social Security
Row 2, Column 1
IP PIN
Row 2, Column 2
Date of Birth
Row 2, Column 3
Relationship
Row 2, Column 4
Name
Row 3, Column 0
Social Security
Row 3, Column 1
IP PIN
Row 3, Column 2
Date of Birth
Row 3, Column 3
Relationship
Row 3, Column 4
Name
Row 4, Column 0
Social Security
Row 4, Column 1
IP PIN
Row 4, Column 2
Date of Birth
Row 4, Column 3
Relationship
Row 4, Column 4
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27
Why do you and your child have different last names? (If Applicable If Not Put NA)* This field is required.
28
Please select all forms of Income* This field is required.
1099 NEC
SELF EMPLOYED
1099R
1099-SSA
W2
29
Did you have health insurance coverage at any time during the 2026 tax year?* This field is required.
Yes, for the full year
No
30
What type of coverage did you have?* This field is required.
Employer-sponsored
Marketplace/ACA Plan
Medicaid/Medicare
Other
31
Did you receive Unemployment Benefits?* This field is required.
Yes
No
32
If so, please specify the amount and attach the 1099-G form.
33
Please attach the 1099-G form.
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Select files to upload
Max. file size: 10.6MB
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34
Are you self employed? (1099 independent Contractor Uber, Lyft, etc)* This field is required.
Yes
No
35
Name of Business* This field is required.
36
EIN Number* This field is required.
37
Business 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
38
When did your business start? Can you specify the month and year? * This field is required.
39
Do you have a Business license? * This field is required.
40
Do you have employees or contractors?* This field is required.
41
How do you keep your business records?* This field is required.
42
How Did you calculate your income? * This field is required.
43
Do you have business expenses? * This field is required.
44
List Business Expenses* This field is required.
Amount $
Advertising
Row 0, Column 0
Travel
Row 1, Column 0
Rent/Lease
Row 2, Column 0
Meals
Row 3, Column 0
Supplies
Row 4, Column 0
Office Expense
Row 5, Column 0
Depletion
Row 6, Column 0
Contractor Labor
Row 7, Column 0
Insurance (other than health)
Row 8, Column 0
Commission and fees
Row 9, Column 0
Rent or lease of equipment
Row 10, Column 0
Rent or lease of property
Row 11, Column 0
Taxes and licenses
Row 12, Column 0
Meals (50%) Enter 100% of the expenses.
Row 13, Column 0
Meals (80%) Enter 100% of the expenses.
Row 14, Column 0
Utilities
Row 15, Column 0
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
Amount $
Row 0, Column 0
Amount $
Row 1, Column 0
Amount $
Row 2, Column 0
Amount $
Row 3, Column 0
Amount $
Row 4, Column 0
Amount $
Row 5, Column 0
Amount $
Row 6, Column 0
Amount $
Row 7, Column 0
Amount $
Row 8, Column 0
Amount $
Row 9, Column 0
Amount $
Row 10, Column 0
Amount $
Row 11, Column 0
Amount $
Row 12, Column 0
Amount $
Row 13, Column 0
Amount $
Row 14, Column 0
Amount $
Row 15, Column 0
1 of 16
45
Taxpayer's ID and/or Driver's License* This field is required.
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Max. file size: 10.6MB
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46
Taxpayer's and Dependent(s) Social Security Card(s)* This field is required.
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Max. file size: 10.6MB
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47
Dependent(s) Birth Certificate(s)
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Max. file size: 10.6MB
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48
Proof of Residency (Lease Agreement or/Utility Bill) if you are filing (Head of Household)
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Max. file size: 10.6MB
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49
PLEASE UPLOAD W2, 1099 INCOME* This field is required.
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Select files to upload
Max. file size: 10.6MB
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50
Additional Documents ( Marketplace Insurance 1095-A)
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Select files to upload
Max. file size: 10.6MB
Browse Files
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51
How would you like to receive your tax refund?* This field is required.
Check
Deduct From Refund (Refund Transfer or Bank Produc (Direct Deposit)t
Prepaid Card (The card will be provided to you)
52
Name of Bank (ONLY IF YOU ARE DOING DIRECT DEPOSIT)
53
Which type of account would you like your refund deposited into?
Checking Account
Savings Account
54
Routing Number* This field is required.
55
Account Number* This field is required.
56
Taxpayer Signature* This field is required.
57
Spouse Signature
58
Date* This field is required.
Date
Month
Day
Year
59
Date
Date
Month
Day
Year
Should be Empty: