Tax Client Intake Form 2021


Tax Client's Name

Address

Street Address
Address Line 2
City
State/Region/Province
Postal/Zip Code
Country


CLIENT INFORMATION

All fields marked with * are required and must be filled.


WELCOME!

To ensure we have the information we need to best serve you, please take a few minutes to fill out the form below. If you have any questions, please feel free to email us at [email protected] at any time. Thank you!


Taxestogo 6 digit code

Email you registered with Taxestogo

If someone referred you, please type his or her name here.

How did you hear about us?

How would you like to receive your tax refund?

If Direct Deposit, which type of account would you like your refund deposited into?

Name of Bank

Routing Number

Bank Account Number

Taxpayer Name

First Name
Last Name

Taxpayers Birthdate

dd-MMM-yyyy

Taxpayer's Email

Taxpayers Phone Number

Taxpayers Social Security Number

Spouse's Name

First Name
Last Name

Spouse's Phone Number

Spouse's Job Title

Spouse's Social Security Number

Spouse's Birthdate

dd-MMM-yyyy

Spouse's Email

Address

Street Address
Address Line 2
City
State/Region/Province
Postal/Zip Code


PREFERRED CONTACT METHOD

Filing Status

Dependent #1 Name

First Name
Last Name
Middle Name

Dependent #1 Birthdate

dd-MMM-yyyy

Dependent #1 Social Security Number

What is Dependent #1's relationship to you? (Son, daughter, parent, etc.)?

How many months did Dependent #1 live with you in 2021? (If all year, enter 12)

Dependent #2 Full Name

First Name
Last Name
Middle Name

Dependent #2 Birthdate

dd-MMM-yyyy

Dependent #2 Social Security

What is Dependent #2's relationship to you? (Son, daughter, parent, etc.)?

How many months did Dependent #2 live with you in 2021? (If all year, enter 12)

Dependent #3 Full Name

First Name
Last Name
Middle Name

Dependent #3 Birthdate

dd-MMM-yyyy

Dependent #3 Social Security

What is Dependent #3's relationship to you? (Son, daughter, parent, etc.)?

How many months did Dependent #3 live with you in 2021? (If all year, enter 12)

Dependent #4 Full Name

First Name
Last Name
Middle Name

Dependent #4 Birthdate

dd-MMM-yyyy

Dependent #4 Social Security

How many months did Dependent #4 live with you in 2021? (If all year, enter 12)

What is Dependent #4's relationship to you? (Son, daughter, parent, etc.)?

What High School did you attend?

Did you receive Unemployment?


I am giving Fresh Start Business Service LLC and/or associated affiliates permission to prepare all forms related to my tax return and I have signed all necessary forms to file my income tax return electronically. I take full responsibility for the accuracy of this client intake form and understand that Fresh Start and/or associated affiliates hold no responsibility for any misrepresentation or false claims.

UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE EXAMINED THIS TAX RETURN, ACCOMPANYING SCHEDULES AND STATEMENTS, AND TO THE BEST OF MY KNOWLEDGE THEY ARE TRUE AND CORRECT.

Clear
Signature
Date

Name

First Name
Last Name

Are you married?

Have you ever been disallowed the EITC/ A0TC/CTC ?

If so, when?

Did you live in the United States?

Address

Street Address
Address Line 2
City
State/Region/Province
Postal/Zip Code
I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.