CLIENT INTAKE FORM

Please also note that to comply with federal and state identity theft protection efforts our firm will ask for a valid state issued photo identification card during your engagement.

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This questionnaire has been divided into sections and may take you upto 30 minutes to complete. Organize all your tax documents and save yourself the hassle of having to come to our location to get your taxes done.

Please enter your preparer name here *

First Name *

Last Name *

Address *

City *

State

Postal code

Email *

Phone *

Occupation *

Social Security Number *

Date of birth *

IP PIN #

Driver's license *

Upload your Driver's License (front and back, not expired)

Does any of these apply?

Spouse Full Name

Spouse Phone number

Spouse Date of birth

Spouse IP Pin

Occupation (copy) *

Spouse Social Security Number *

Spouse Driver's license *

Upload your Driver's License (front and back, not expired)

Does any of these apply for spouse?

TAXPAYER (&) Dependent Social Security

Please upload a copy of your and the dependents social security cards OR other document that has SSN on it. (Please take clear pics. If you were a last year client and filing the SAME dependent, you do not need to upload anything.)

DEPENDENT 1

FULL NAME
RELATIONSHIP
DATE OF BIRTH
SOCIAL SECURITY #
HOW LONG DID DEPENDENT LIVE IN HOUSEHOLD WITH YOU

DEPENDENT 2

FULL NAME
RELATIONSHIP
DATE OF BIRTH
SOCIAL SECURITY #
HOW LONG DID DEPENDENT LIVE IN HOUSEHOLD WITH YOU

DEPENDENT 3

FULL NAME
RELATIONSHIP
DATE OF BIRTH
SOCIAL SECURITY #
HOW LONG DID DEPENDENT LIVE IN HOUSEHOLD WITH YOU

DEPENDENT 4

FULL NAME
RELATIONSHIP
DATE OF BIRTH
SOCIAL SECURITY #
HOW LONG DID DEPENDENT LIVE IN HOUSEHOLD WITH YOU

Do you pay childcare expenses for any dependent listed?

YES

PLEASE LIST THE FOLLOWING INFORMATION

PROVIDER NAME /COMPANY
EIN/SSN
PHONE NUMBER
ADDRESS
HOW MUCH DID YOU PAY MONTHLY
WHICH KID(S) ATTENDED

Are you filing a business/self-employed/side job/cash job? If yes, describe the nature.

Type of Income

Income Documents

Profit & Loss Statement, Income Statement, Bank Statement, etc

Expense Documents

Profit & Loss Statement, Purchase Receipts, Invoices, etc

Upload W2 Form(s)Tax Documents

W2, 1099's, Mortgage Interest, 1098-T, etc

Upload W2 Form(s)Tax Documents

W2, 1099's, Mortgage Interest, 1098-T, etc.

Did you or your family have health insurance at any time in 2024 FROM THE MARKETPLACE? HEALTHCARE.GOV * *

Yes

1095-A

Upload the 1095A

Which disaster was you affected by and listed things you lost?

Were you affected by A national disaster during this tax year

YES

How would you like your refund? *

Bank Name *

Account Number *

Routing Number *

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.

Would you like to apply for the advance up to $7500? (It all depends on the amount of your refund). There are two types of refund advances. PREACK (before the IRS OPENS Jan2 until the IRS opens) and INSEASON (when the IRS opens)

Whatever method you use for refund advance, you'll receive refund the same way! It can't be changed even if you're denied.

Preack- Harder look at credit, but not specifically credit based. Refund History for last 5 years. 3 out of 10 clients receive it. If you are denied, there is another opportunity for you to apply for the in-season loan.

In Season- Easier to get. Refund history from previous year. 4 out of 5 of my clients receive it. If you are denied, there is not any more funding.

**DISCLAIMER: DESPITE ODDS, REFUND ADVANCES ARE NOT GUARANTEED

THE BANK CAN APPROVE YOU FOR THE AMOUNT REQUESTED, DENY YOU, OR APPROVE YOU FOR A LESSER AMOUNT**

Would you like to apply for the advance up to $7,500? *

Yes

How much would you like?

UP TO 1,000

MORE THAN 1,000

What is the name of the High school you last attended?

FOR BANKING REASONING ONLY

Acknowledgement

I understand that the refund advance is not guaranteed and that loans over $1,000 will have small interest fee.