2022 TAX CLIENT INTAKE
How did you hear about us?
FACEBOOK
INSTAGRAM
REFERRAL
PREVIOUS CLIENT
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If someone referred you, please type his or her name here.
Taxpayer's First Name
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Taxpayer's Last Name
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Phone
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Email
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Address
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City
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State
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Zip code
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Are you trying to buy a new home within the next 2 years?
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YES
NO
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Taxpayer's SSN
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Taxpayer's Job Title
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Taxpayer's Date of Birth
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Filing Status
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HEAD OF HOUSEHOLD
SINGLE
MARRIED FILING JOINTLY
MARRIED FILING SEPARATELY
QUALIFIED WIDOW(ER) (WITH DEPENDENT CHILD)
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Spouse's Full Name(if applicable)
Spouse's SSN
Spouse's Date of Birth
Spouse's Phone Number
Spouse's Email Address
Spouse's Job Title
Did you and your spouse live apart during the year?
YES
NO
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Are you self employed?
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YES
NO
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What is your marital status as of December 2022?
SINGLE (not married)
MARRIED LIVING WITH SPOUSE
MARRIED NOT LIVING WITH SPOUSE
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Did you support a child or family member for more than 6 months out of the year?
YES
NO
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If yes, did you live together at any time after June 30, 2022?
YES
NO
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Did you pay over half the expenses of maintaining your residence for the entire year?
YES
NO
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How many dependents are you claiming?
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ONE
TWO
THREE
NONE
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Dependent #1
Dependent #1 Date of Birth
Dependent #1 SSN
What is Dependent #1's Relationship to you (son, daughter, etc.)?
How many months did Dependent #1 live with you in 2022? (If all year, enter 12)
Dependent #2
Dependent #2 SSN
Dependent #2 Date of Birth
How many months did Dependent #2 live with you in 2022? (If all year, enter 12)
Dependent #3
Dependent #3 SSN
Dependent #3's Date of Birth
How many months did Dependent #3 live with you in 2022? (If all year, enter 12)
How would you like to receive your tax refund?
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CHECK
DIRECT DEPOSIT
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Name of Bank
Which type of account would you like your refund deposited into?
CHECKING
SAVINGS
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Routing Number
Account Number
Can someone else claim you as a dependent?
*
YES
NO
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Was your insurance through the Affordable Care Act (The Marketplace)?
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YES
NO
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Upload Taxpayer & Dependent(s) Insurance Documents form 1095A if applicable
Were you or any of your dependents in college in 2022?
YES
NO
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If you have a 1098-T form, upload it here.
Taxpayer's Driver's License
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Taxpayer's and Dependent(s ) Social Security Card(s)
Taxpayer's W-2/ 1099'S AND/OR Business Receipts
Dependent(s) Birth Certificate(s)
Payment Methods:
CLIENT NON PAYMENT/OFFSET CLAUSE -At Enfocus Financial LLC, we strive to assist all of our clients in their tax needs, however we understand that situations arise. If your refund is offset by the IRS, student loans, child support or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return. By signing this agreement you acknowledge that if payment is not made in full with in 30 days legal actions will be sought to resolve payment.
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I AGREE
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You the taxpayer do agree that all of the information that you have provided is ACCURATE, HONEST AND TRUTHFUL to the best of your ability. I, Jacquenia Williams will not be held responsible for any inaccurate, fraudulent or deceptive acts committed by you, the taxpayer.
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I AGREE
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TYPE YOUR ELECTRONIC SIGNATURE BELOW
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TODAY'S DATE
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Have a question for us? Let us know below
ADDITIONAL SERVICES At Enfocus Financial LLC, we do more than just taxes. Please check below if you would be interested in any of the additional services we provide. We will schedule a time to speak with you.
BUY A CAR
CREDIT REPAIR
BUSINESS FORMATION
BUSINESS CREDIT
TRADELINES
CPN
APARTMENT OR HOME RENTAL
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