Tax Client Intake Form

Taxpayer Information

Current Tax Year

Did you file with us last year?

Yes

Filing Status

First Name

Last Name

Phone *

Email *

Social Security Number

Address *

Street Address

City

State

Country

Postal Code

Dependent 1 Information

Dependent 1 Name

Dependent 1 Date of Birth

Dependent 1 Social Security Number

Relationship

How many months did they live in your home for the current year?

Did this dependent attend college this year?

Yes

Do you want to add a 2nd dependent?

Yes

Dependent 2 Information

Dependent 2 Name

Dependent 2 Date of Birth

Dependent 2 Social Security Number

Relationship 2

How many months did they live in your home for the current year? (2nd dependent)

Did this 2nd dependent attend college this year?

Yes

Do you want to add a 3rd dependent?

Yes

Dependent 3 Information

Dependent 3 Name

Dependent 3 Date of Birth

Dependent 3 Social Security Number

Relationship 3

How many months did they live in your home for the current year? (3rd dependent)

Did this 3rd dependent attend college this year?

Yes

Do you want to add a 4th dependent?

Yes

Dependent 4 Information

Dependent 4 Name

Dependent 4 Date of Birth

Dependent 4 Social Security Number

Relationship 4

How many months did they live in your home for the current year? (4th dependent)

Did this 4th dependent attend college this year?

Yes

Do you want to add a 5th dependent?

Yes

Dependent 5 Information

Dependent 5 Name

Dependent 5 Date of Birth

Dependent 5 Social Security Number

Relationship 5

How many months did they live in your home for the current year? (5th dependent)

Did this 5th dependent attend college this year?

Yes

Do you want to add a 6th dependent?

Yes

Dependent 6 Information

Dependent 6 Name

Dependent 6 Date of Birth

Dependent 6 Social Security Number

Relationship 6

How many months did they live in your home for the current year? (6th dependent)

Did this 6th dependent attend college this year?

Yes

Do you want to add a 7th dependent?

Yes

Dependent 7 Information

Dependent 7 Name

Dependent 7 Date of Birth

Dependent 7 Social Security Number

Relationship 7

How many months did they live in your home for the current year? (7th dependent)

Did this 7th dependent attend college this year?

Yes

Do you want to add a 8th dependent?

Yes

Dependent 8 Information

Dependent 8 Name

Dependent 8 Date of Birth

Dependent 8 Social Security Number

Relationship 8

How many months did they live in your home for the current year? (8th dependent)

Did this 8th dependent attend college this year?

Yes

Do you want to add a 9th dependent?

Yes

Dependent 9 Information

Dependent 9 Name

Dependent 9 Date of Birth

Dependent 9 Social Security Number

Relationship 9

How many months did they live in your home for the current year? (9th dependent)

Did this 9th dependent attend college this year?

Yes

Do you want to add a 10th dependent?

Yes

Dependent 10 Information

Dependent 10 Name

Dependent 10 Date of Birth

Dependent 10 Social Security Number

Relationship 10

How many months did they live in your home for the current year? (10th dependent)

Did this 10th dependent attend college this year?

Yes

The cash advance gives you up to $7500 of your refund prior to the IRS processing and issuing your refund. You don’t have to pay any upfront costs. The amount that you’re approved for varies and if you are approved, you will receive the funds within 24 to 48 hours.

Would you like a cash advance: *

Yes

Authorization & Consent

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

Taxpayer Signature *

Clear

Date (Taxpayer)

Spouse Signature

Clear

Date (Spouse)