PERSONAL INFORMATION

Full Name *

Address *

Street Address

City

State

Country

Postal Code

Date of birth *

SSN or ITIN *

Phone *

Email *

If you have an IP PIN, please enter it here. If you are not sure if you have an IP PIN, you can quickly and easily acquire one on the IRS website, by Googling "get an IP PIN".

Marital Status as of December 31 of the tax year: *

Single

Married

Divored

Widowed

If married:

Spouse’s Full Name:
Spouse's DOB
Spouse’s SSN or ITIN:
Did you live together all year?
Spouse's IP PIN

Upload ID(s) *

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Upload ID(s)

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DEPENDENT INFORMATION

Do you have dependents you support financially? *

Do you financially support any adult relatives (parents, grandparents, others)? *

If yes, please explain relationship and level of support:

For each dependent, please provide Full Name, Date of Birth, Relationship to You, SSN, are they disabled, did they live with you more than half the year? PLEASE NOTE: You can not claim dependents without all of this information. If any of this information is left off this form, the dependent will not be added to your return.

Upload IDs, Social Security Cards, or other dependent documents. PLEASE NOTE: You can not claim dependents who you can not prove support for.

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Did you pay any childcare or dependent care expenses?

Upload proof of care expenses and supporting documents

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TAX SCENARIO QUESTIONS

Did you have health insurance during the year? *

Employer-provided

Private insurance

Marketplace insurance

No insurance

If you had Marketplace Insurance and received a 1095-A, upload here.

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Medical expenses paid out of pocket: (Please provide amounts)

Doctor Visits
Prescriptions
Vision & Dental
Insurance premiums

Did you: *

Make estimated tax payments?

Receive stimulus payments

Receive advance child tax credits

None of the above

Do you: *

If you own, please list the yearly amount of:

Mortgage interest paid
Property taxes paid
Homeowners insurance paid

Are you interested in: *

Did you receive any of the following:

1098-T

Student loan statements

Did you pay any of the following? If yes, provide amounts:

Student loan interest
Tuition or education expenses
Education expenses for dependents

REFUND INFORMATION

Do you expect to receive a refund? *

If you expect a refund, would you like your tax prep fee deducted from you refund? NOTE: If you don’t expect a refund, the fee must be paid before filing. *

We are able to offer Refund Advances up to $7,500 to our approved clients. Are you interested in receiving a Refund Advance?

Direct Deposit information *DOUBLE CHECK FOR TYPOS* DO NOT leave this blank! PLEASE NOTE: If you leave this blank and receive a refund, your refund will be mailed to you and you will not be able to pay your Tax Prep fee from your refund. If you leave this blank and you owe, we will not be able ro assist with a payment plan:

Bank name:
Routing number:
Account number:
Checking or Savings?

INCOME INFORMATION

Upload all W2, 1099, and other income statements here. *

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Upload additional income statements here.

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Do you work from home? *

If you do work from home:

Total square footage of home:
Square footage used exclusively for business:

(If you do work from home) Utilities paid during the year:

Electricity
Gas
Water
Trash
Internet
Lawn Care & Maintenance
Security System

Business Name (if any):

Type of Business:

Business Structure:

Sole Proprietor

LLC

S-Corp

Partnership

Did you have business expenses?

Upload business income and expense documents here. PLEASE NOTE: There may be an additional charge for bookkeeping services on un-categorized or disorganized expenses.

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Many people choose not to report small amounts of side-hustle or freelance income because it seems insignificant. However, reporting this income can often create valuable tax advantages by allowing eligible business deductions that may reduce overall taxable income and support future financial goals.

Did you earn any income outside of a regular job, even if small? *

If yes, please describe the activity and approximate income:

FINAL ACKNOWLEDGMENT

Anything else you paid for that you think may be tax-related?

Any other information you think may be helpful?

I confirm that the information provided is complete and accurate to the best of my knowledge. I understand that missing or inaccurate information may affect my tax outcome. *

Yes

Signature *

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