Eleven22 Financial Excellence Client Intake Form 2026

Welcome to Eleven22 Financial Excellence. Let's prepare your 2026 tax season return with accuracy, speed and care.

PLEASE READ THROUGH THIS THOROUGHLY!

Do not submit this form until you have all supporting documents.

By not following directions your intake form will not be processed.

Please complete the following intake form as it relates to your Tax Return. Complete every question. (All forms required)

Be sure to have all documents available before starting the process. It will take 20-30 minutes to complete this form.

NOTE: If you are claiming dependents be sure to upload their SS Cards, Birth Certificates and items that show their address the same as yours (School records, medical records, doctor bill, Medicaid statement, Social Security records or anything that shows child's current name and address)

PLEASE DO NOT SUBMIT THIS FORM UNTIL YOU HAVE ALL SUPPORTING DOCUMENTS. DO SO WILL DELAY THE PROCESSING OF YOUR RETURN!

What year is this entry for? Please only upload documents for the year mentioned. If you need to submit multiple years, file out a form for each year(s).

Is this an amendment?

Yes

No

Did you need a tax consultation?

Yes

No

Are you a new or returning client?

Yes

No

Personal Details

First Name

Middle Name

Last Name

Date of birth

Social Security Number#

Occupation

Email

Confirm Email

Phone

Cell Phone Provider

Street Address

City

State

Country

Zip Code

Is this a NEW address with the IRS?

Yes

No

Can another taxpayer claim you as a dependent on their tax return?

Yes

No

Are you legally married?

Yes

No

Dependent 1

Dependent Full Name

Dependent DOB

Dependent SSN

How many months this dependent has lived in your home in 2025?

Relationship

Dependent 2

Dependent 2 Full Name

Dependent 2 DOB

Dependent 2 SSN

How many months this dependent 2 has lived in your home in 2025?

Dependent 2 Relationship

Do you have more dependents

Yes

No

Dependent 3

Dependent 3 Full Name

Dependent 3 DOB

Dependent 3 SSN

How many months this dependent 3 has lived in your home in 2025?

Dependent 3 Relationship

Did you pay any childcare expenses for any dependents?

Yes

No

Did you, your spouse, or any dependent attend college in 2023?

Yes

No

Did you receive health insurance through Market Place?

Yes

No

If you own a home, have you recieved form 1098 from your mortage lender?

Yes

No

Did you or your spouse receive unemployment benefits?

Yes

No

Did you or your spouse make payments on student loans in 2023?

Yes

No

What method is best for you to receive your refund?

Do you owe any debt to the following government agency; IRS, Student Loans, Child Support, ETC?

Yes

No

Do you receive foodstamp?

Yes

No

Are you self-employed or a business owner?

Yes

No

Do you owe debt to any government agency, such as the IRS, Student Loans, Child Support, etc?

Yes

No

Do you have the IRS IP Pin?

Yes

No

If you are a new client: Do you have a copy of tax return from last year?

Yes

No

Are you interested in Audit Protection? ($69 fee)

Yes

No

Are you interested in Advanced Loan up to $7,000?

Yes

No

If you own your home, Have you received 1098 form from your lender?

Yes

No

Do you receive Section 8?

Yes

No

IF YOU ARE NOT SURE, WHETHER OR NOT YOU OWE A GOVERNMENT AGENCY CALL 1-800-304-3107.

How would you like to receive your Refund?

Debit Card ( Supplied in the Office )

Direct Deposit

* ALL FIELDS ARE REQUIRED TO BE FILLED OUT *

Tax Documents

Please attach all tax documents below. Make sure all pages are clear and we can see the full page. If its multiple pages please upload as a PDF. (If you are using your IPHONE you can go to notes: scan the documents and it will turn it into a PDF)

Upload Tax Documents Here 1

Tax Documents (W-2, 1099, 1098-T, ETC)

Did you withdraw from your 401 during the year?

Yes

No

Upload Direct Deposit Account and Routing Number

IPPIN IDENITITY THEFT (IF APPLICABLE) Take a clear picture and upload. (Letter or Screenshot form IRS Account)

Enter IPPIN here

Do you want to Upload Tax Documents 2 ?

Yes

No

Tax Documents (W-2, 1099, 1098-T, ETC)

Tax Documents (W-2, 1099, 1098-T, E.T.C)

Tax Document (W-2, 1099, 1098-T, E.T.C)

Did you withdraw from your 401 during the year(s) ?

Yes

No

Upload Your Direct Deposit Account and Routing Number

IPPIN IDENITITY THEFT (IF APPLICABLE) Take a clear picture and upload. (Letter or Screenshot(s) form IRS Account)

Enter Your IPPIN here

Taxpayer Social Security Card(s)

Dependent Social Security Cards

Dependent Social Security Cards 2 (If Applicable)

Drivers License/ State ID

Spouse Driver's License/ State ID

Birth Certificates for Dependents

Is there anything you need us to know while preparing your tax return?

Would you like to refer us a client? We can reach out to them and let them know you referred them!

Yes

No

Family/ Friend Full Name

Family/ Friend Phone Number

Client Acknowledgement and Authorization

By signing this form, I acknowledge the following:

Payment of Services
I understand that I am paying for the preparation of my tax return, regardless of whether I receive a refund or not. If your tax refund if offset, you will be responsible for your Tax Preparation payment.
Accuracy of Information
I confirm that all information I have provided to Eleven22 Financial Excellence, LLC is true and accurate to the best of my knowledge.
Supporting Documentation
I understand that I am responsible for providing all necessary supporting documentation to validate the information I have provided.
Legal Responsibility
I understand that knowingly providing false information for my tax return constitutes a criminal offense, which may result in legal consequences, including court appearances, restitution, and possible imprisonment.
Liability Waiver
I release Eleven22 Financial Excellence, LLC and its preparers from any liability for errors resulting from incorrect or inaccurate information I have provided.
Authorization to File
By signing below, I authorize Eleven22 Financial Excellence, LLC to prepare my 2025 tax return for the 2026 filing season and consent to receive text or email communications related to my return.

Taxpayer's Signature

Clear

Spouse's Signature

Clear

Today's Date