TAX PREP CLIENT INTAKE FORM

Filing Status *

TAXPAYER INFORMATION:

Full Name *

Date of birth

Phone *

Email *

Full Social Security Number

Address

Street Address

City

State

Country

Postal code

Your 6-digit IP-PIN Number from IRS

Occupation

Are you a full-time student?

Yes

No

Are you totally and permanently disabled?

Yes

No

Would You Like a Same Day Tax Refund Advance up to $9500.00

Yes

No

How would you like to receive your Tax Advance/Tax Refund?

Check

Direct Deposit

Bank Name

Bank Routing Number

Bank Account Number

SPOUSAL INFORMATION

Spouse Full Name

Spouse Date Of Birth

Phone Number

Email Address

Spouse Full Social

Spouse 6-Digit IP PIN

Spouse Occupation

Are they a full-time student?

Yes

No

Are they totally and permanently disabled?

Yes

No

DEPENDANTS:

1. Name, DOB, and Social

2. Name, DOB, and Social

3. Name, DOB, and Social

4. Name, DOB, and Social

5. Name, DOB, and Social

TAX RELATED QUESTIONS:

Are you a Business Owner?

Business Name

Business Address

Business EIN # (enter social if no EIN)

BUSINESS EXPENSES:

Enter the following expenses total amount

Advertising
Contract Labor
Commission and fees
Depletion
Employee benefit programs
Legal and professional services
Office expense
Pension and profit sharing
Rent or lease of equipment
Rent or lease of property
Repairs and maintenance
Supplies
Taxes and licenses
Travel
Meals
Utilities
Wages
Insurance

Total Expenses

DOCUMENT UPLOAD:

Upload Yours and/or Your Spouses ID and Social Security Card

Upload Dependents Birth Certificates and Social Security Cards

Upload W2s, 1099s, Unemployment or Income Verification Documents

Upload All supporting Documents for your Business (Business Registration, EIN, Expenses, Income, Flyers, Receipts, Business Card, Etc)

Upload 1098-T for College Credits and/or Childcare Receipts

Upload Previous 1040 (Required for Amendments Only)

Upload All Other Documents for Health Insurance, Mortgage Insurance, Charitable Contributions, Investments, Etc

ACKNOWLEDGMENT & SIGNATURE

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

How did you hear about us?

Returning Client

Online/Marketing

Client Referral

Enter Your Referral Code

Date Signed *

Taxpayer Signature *

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