Tax Client Intake Form

Taxpayer Information

Tax Year Filing

Did you file your tax with us last year?

Yes

No

How were you referred?

Filing Status

Multi Dropdown

Single
Head of Household
Married Filling Joint
Married Filling Separate
Qualifying Widower
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Tax payer Name *

Phone *

Email *

Social Security Number

Mailing Address *

City

State

Country

Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
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
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Cote D"Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea People's Democratic Republic
Republic of Korea
Kuwait
Kyrgyzstan
Land Islands
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
North Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Federated States of Micronesia
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
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
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Eswatini
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
UK
Ukraine
United Arab Emirates
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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Zip code

Date Of Birth

Marital Status

Never Married
Married
Divorced
Legally separated
Widowed
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Occupation

Are you a U.S. Citizen or a Green Card holder?

U.S Citizen

Green Card holder

Dependent Name

Dependent DOB

Client provided identification

Form of identification *

State issued ID

State issued Drivers license

Passport

ID number *

Issue Date

Expiration Date

Attach Photo Identification

or drag files here.

Are you a full-time college student?

Yes

No

Are you totally and permanently disabled?

Yes

No

Are you legally blind?

Yes

No

Are you claiming any dependents?

Yes

No

Is this individual dependent of other?

Yes

No

Do you owe tax debt? ie; Student loan, Child support, IRS

Yes

No

Did you get government assistance?

Yes

No

Banking

Banking Information

Bank Name

Bank Routing Number

Bank Account Number

7216 Bank Consent to Disclosure of Tax Return Information

Clear

(Spouse) 7216 Bank Consent to Disclosure of Tax Return Information

Clear

Spousal Information

Spouse Name

Spouse phone number

Spouse Email

Spouse's Social Security #

Date of Birth

Date of Death

Are you a full-time student?

Yes

No

Are you legally blind?

Yes

No

Is this individual dependent of other?

Yes

No

Are you totally and permanently disabled?

Yes

No

Are you claiming any dependents?

Yes

No

Independent Information

List the names below of everyone who lived with you last year (other than your spouse), or anyone you supported but did not live with.

How many Dependent do you have?

1
2
3
4
5
6
7
8
9
10
No elements found. Consider changing the search query.
List is empty.

Name

Single Line 127xt2

Last Name

Single Line 124guo

Date Of Birth

Single Line 125xj4

Social Security Number

Single Line 128ii9

Relationship

Single Line 126sj8

How many months did they live in your home for the current year?

Tax Related Questions

Employment Status

Employed
Unemployed
Self-Employed
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Are you contributing to 401k or other pre-tax account outside of your employer?

Yes

Do you plan on making any major purchases within the year ie; House, land, business etc.?

Yes

No

Did you recieve any distributions from this account(s) during the tax filing year?

Yes

No

Does your dependent(s) have tuition expenses?

Yes

No

Do you have any expenses for child care?

Yes

No

Do you own your home?

Yes

No

Did you recieve Health Insurance through healthcare.gov/Marketplace?

Yes

No

Do you and, or your dependant have an identity issued PIN?

Yes

No

Do you have documents that show you paid for property taxes?

Yes

No

Income

Please select all forms of income in the current tax year: *

Wages or Salary (W2 Income)

Unemployment

Pension/Retirement Income

Rental Income

Farm Income

Dividend/Sale of Stocks

Interest Income

Self-Employment-Bus. Income (Sch.C)

Alimony Received

Lottery or Gambling Income W-2G

Public/State Aid Income

Social Security Income

Tips

Other

1099 INT, DIV, OID

or drag files here.

General/Itemized Expenses

Medical Expenses

$

Dental Expenses

$

Insurance Premiums paid

$

Long Term Care Premiums

$

Investment Interest

$

Prescription Drugs and Medications

$

Cash Contributions

$

Non-Cash Contributions

$

Tax Preparation Fees

$

Union Dues

$

Investment Expenses

$

Educator Expenses

$

Student Loan Interest

$

IRA Expenses

$

Sales Taxes paid

$

Upload General/Itemized expense evidence here:

or drag files here.

Schedule C Expenses

Advertising Expenses

$

Contract Labor Expenses

$

Depletion Expenses

$

Employee Benefit program

$

Insurance (Other than health)

$

Interest on Mortgage

$

Self Employee Health Insurance

$

Other Interests

$

Profit Sharing & Pension

$

Office Expenses

$

Supplies

$

Rent or Lease of Equipment

$

Repairs & Maintenance

$

Rent or Lease of Property

$

Travels

$

Taxes and Licenses

$

Entertainment & Meals

$

Utilities

$

Types of Utilities

Wages (less employee credits)

$

Car & Truck Expenses

$

Business miles before 7/1

Business miles after 6/30

Description of vehicle

Date you placed vehicle in service for business purposes

Do have evidence to support your deductions

Yes

No

I confirm that all information I entered here is accurate and true.
I allow you 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.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.

Taxpayer Signature

Clear

Date

Spouse Signature

Clear

Date