Intake Form

CLIENT INTAKE FORM

IMPORTANT – PLEASE READ

DO NOT SUBMIT UNTIL YOU HAVE ALL FORMS NEEDED TO FILE

What Tax Year *

2025

2024

2023

2022

Is this your first year filing with us last year *

Yes

No

Are you being claimed on someone elses tax return? *

Yes

No

What's your Previous year AGI? *

Who referred you? *

TAXPAYER INFORMATION:

Full Name *

Date of birth *

MM-DD-YYYY

Email so we can send 1040 once paid. *

Phone *

Social Security Number *

Re-enter Social Security Number *

Street Address *

City *

State *

Postal code

county *

Occupation *

Are you a full-time student?

Yes

No

Banking Information:

Account Number *

Routing *

SPOUSAL INFORMATION (• Married filing jointly: add your spouse’s information here.
• Spouse Filing Separately: please complete a separate intake form for your spouse.)

Spouse Full Name

Spouse Date Of Birth

MM/DD/YYYY

Spouse Social Security Number

Re-enter Spouse Social Security Number

Spouse Occupation

Are they a full-time student?

Yes

No

Are they totally and permanently disabled?

Yes

No

Are you claiming any dependent? *

Yes

No

DEPENDANTS: IF YOU ARE CLAIMING THEM THIS YEAR

DEPENDANT 1 FULL NAME

DEPENDANT 1 SOCIAL SECURITY

DEPENDANT 1 DOB

DEPENDANT 2 FULL NAME

DEPENDANT 2 SOCIAL SECURITY

DEPENDANT 2 DOB

DEPENDANT 3 FULL NAME

DEPENDANT 3 SOCIAL SECURITY

DEPENDANT 3 DOB

DEPENDANT 4 FULL NAME

DEPENDANT 4 SOCIAL SECURITY

DEPENDANT 4 DOB

TAX RELATED QUESTIONS:

Employment Status

Are you contributing to 401k or other pre-tax account?

Yes

No

Are you currently renting?

Yes

No

What is the monthly rental amount?

Are you planing on getting a home this year? *

Yes

No

MEDICAL INSURANCE QUESTION:

Do you have medical insurance? *

Yes

No

If yes, upload your Marketplace Form 1095-A here

Do not upload your insurance card. Only upload Form 1095-A if you had Marketplace insurance.

How much do you pay a month on health insurance?

Did you purchase a New vehicle this year?

yes

no

How much interest did you pay

Vehicle ID number (VIN)

17 digit number

Cash income

GENERAL EXPENSES:

Enter the following expenses total amount of the year

Medical Expenses
Dental Expenses
Cell Payments
Auto Payments
Prescription Drugs and Medications
Home Mortgage/rent
Utilities
Home office
Membership fees
Supplies
Clothing
Tax Preparation Fees
Fuel Expenses
Other Expenses
Side Job Expenses
Remodel home/office
Auto Insurance
Meals

Load all W2, 1099s , and tax documents here

Tax documents

how many w2 or 1099 you submit

Anything you need us to know

ACKNOWLEDGMENT & SIGNATURE

I confirmed that all information I entered here is accurate and true.
I confirmed that the socials are accurate.
I confirmed that the Bank routing and account numbers are accurate.

Date Signed

Taxpayer Signature

Clear

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.