Are you a new tax client?
*
Yes
No
What tax year are you filing for?
*
Select an option
Filing Status :
*
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Preferred tax preparer
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How do you hear about us?
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Referred by:
Taxpayer's Information
First Name
*
Last Name
*
Social Security Number:
*
Date of birth
Address
Street Address
City
State
Country
Enter your country
Postal Code
Phone
*
Email
*
Tax Payer's Occupation:
*
Spouse Information
Spouse name:
Spouse SSN
Spouse Phone #:
Spouse Email
Spouse Occupation:
Upload a Valid Government-issued Photo ID (Driver’s License, Passport, etc.)
*
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Social Security Card
*
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
1st Income Document (w-2, 1099s, etc..)
*
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
2nd Income Document (w-2, 1099s, etc... )
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
3rd Income Document(w-2, 1099s, etc.)
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
4th Income Document (w-2, 1099s, etc.)
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
5th Income Document (w-2, 1099s, etc.)
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Upload Prior Year Tax Return:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Taxpayer's Other Docs: Upload one of the following to verify Head of Household : Lease, Utility Bill, Mortgage Statement:
*
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Upload Spouse Social Security Card:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Upload Spouse Income document (w-2, 1099s, etc.)
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Spouse Prior Year Tax Return:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Spouse Other Docs:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Dependents
Do you have any dependents to claim on your 2025 tax return?:
*
Select an option
Dependent 1
Dependent 1 Name:
Dependent 1 SSN #:
Dependent 1 Date of Birth:
Dependent Relationship to tax payer:
Did you pay any children expenses for dependent 1:
Dependent 2
Dependent 2 name:
Dependent 2 SSN #:
Dependent 2 date of birth:
Dependent 2 relationship to tax payer:
Did you pay any children expense for dependent 2:
Dependent 3
Dependent 3 name:
Dependent 3 SSN #:
Dependent 3 date of birth:
Dependent 3 relationship to tax payer:
Did you pay any children expense for dependent 3?:
Dependent 4
Dependent 4 name:
Dependent 4 SSN #:
Dependent 4 date of birth:
Dependent 4 relationship to tax payer:
Did you pay any children expense for dependent 4?:
Dependent 1 Social Security Card:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Dependent 1 Birth Certificate:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Dependent 2 Social Security Card:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Dependent 2 Birth Certificate:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Depenedent 3 Social Security Card:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Dependent 3 Birth Certificate:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Dependent 4 Social Security Card:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Dependent 4 Birth Certificate:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Childcare Expenses Information
Childcare Provider Information
Childcare Expenses Documents:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Upload 1098-T from college/ University:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Other Documents:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Tax Return Questions
Have you ever been disallowed for EITC/AOTC/CTC?ACTC?
Yes
No
Did you receive a federal/state refund last year?
Yes
No
Were you audited by the IRS last year?
Yes
No
Any situations that applies for the taxpayer, spouse, or dependents listed (to help us maximize your refund)
Has any credits or deduction in previous year been reduced for any reason by IRS?
Did you, your spouse or dependents receive health insurance through the Marketplace in 2025 and receive Form 1095-A?:
Yes
No
Upload 1095-A Health Insurance Marketplace Statements:
Click to upload
PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF
Other Information:
Identify Protection PIN (IPPIN)
Was the taxpayer, spouse, or any of the dependents issued a IP PIN by the IRS?
Yes
No
Please provide the 6 digit IP PIN provided by the IRS & the person who received one:
Refund/Cash Advance Loans
Would you like to see if you PRE-QUALIFY for a SAME DAY CASH ADVANCE UP TO $9,600?:
Yes
No
How would you like to receive your cash advance refund?:
How would you like to receive your refund?
Select an option
Type of Account:
Direct Deposit- Bank Name
Direct Deposit- Bank Routing #
Would you like to receive a text message when your refund is funded?:
Yes
No
List your cell phone provider here:
IRS FORM 7216 - CONSENT TO USE & DISCLOSE TAX INFORMATION
(Presented as an embedded DocuSign form) I authorize Vital Wealth Financial LLC to use and disclose my tax return information as permitted by law and for the purpose of preparing and filing my tax return and related services.
I CONSENT
I DO NOT CONSENT
Full Name of Client
Client Signature:
Clear
Date Submission:
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