Essential Tax Filing Intake

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CLIENT INFORMATION

First Name *

Last Name *

Address

Street Address

City

State

Postal Code

Email *

Phone *

Preferred Contact Time

Morning
Afternoon
Evening
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IDENTITY & SECURITY

Date Of Birth *

Social Security Number *

Upload Government ID *

IP PIN (Optional)

FILING STATUS & DEPENDENTS

Filing Status

Single
Head of Household
Married Filing Jointly
Married Filing Separately
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How many dependents are you claiming?

List Dependents Full Names

Dependents Name (1)

Date of Birth (1)

Upload Dependent 1 Social Security Cards

Dependents Name (2)

Date of Birth (2)

Upload Dependent 2 Social Security Cards

Dependents Name (3)

Date of Birth (3)

Upload Dependent 3 Social Security Cards

Dependents Name (4)

Date of Birth (4)

Upload Dependent 4 Social Security Cards

Dependents Name (5)

Date of Birth (5)

Upload Dependent 5 Social Security Cards

Dependents Name (6)

Date of Birth (6)

Upload Dependent 6 Social Security Cards

Dependents Name (7)

Date of Birth (7)

Upload Dependent 7 Social Security Cards

Dependents Name (8)

Date of Birth (8)

Upload Dependent 8 Social Security Cards

Dependents Name (9)

Date of Birth (9)

Upload Dependent 9 Social Security Cards

Dependents Name (10)

Date of Birth (10)

Upload Dependent 10 Social Security Cards

INCOME INFORMATION (W2 ONLY)

Did you receive W-2 income?

Yes
No
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Upload all W-2 forms

Did you receive any additional income?

YES

NO

*(1099, self-employment, side work, freelance, gig work, or cash payments)

STOP

We’ve identified that you have business or self-employment income. This means your return needs to be prepared as a business tax return so we can properly report all income and deductions.

Please continue by completing the Tier 2 Intake Form below.

TAX CREDITS & HOUSEHOLD INFO

Did you pay for childcare?

YES

NO

Did you pay for education?

YES

NO

Did you pay rent or utilities?

YES

NO

Do you receive housing assistance?

YES

NO

TAXPAYER FINANCIAL OVERVIEW

What is your current credit score?

Under 550

550–620

620+

Not sure

What are your financial goals this year? (Select all that apply)

Improve credit

Buy a car

Buy a home

Start a business

Increase income

Just file my taxes

Are you interested in learning ways to increase your income or start a business?

Yes

Maybe

No

REFERRAL INFORMATION

How did you hear about us?

Daycare / Head Start
Friend / Family
Social Media
Google
Other
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If referred, who referred you?

Name of daycare or organization (if applicable)

Account type

Account number

Account Routing #

DOCUMENT UPLOAD

Government ID

Dependents’ SS cards (if applicable)

W-2s

Last year’s return (if available)

Any IRS letters received (Optional)

AGREEMENT & SUBMISSION

By signing below. I confirm all information provided is accurate to the best of my knowledge.

Signature *

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