2025 Client Intake FormPlease have all of your documents ready when submitting this form! Type of Client * Returning Client New Client Name * First Name Last Name Date of Birth * MM DD YYYY Date of Death MM DD YYYY Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email * Filing Status * Single Head of Household (Must Provide Documents) Married Filing Jointly Qualifying Widower Married Filing Separately Occupation Do any of the following apply? Deceased Blind Can be claimed as a dependent Referred by: Do you have dependents? * Yes No Would you like to apply for a refund advance? * Yes No Undecided, show me the terms Are you filing a business/self employed/side job/cash job? * Yes No Do you owe student loans, taxes, or other entity that might offset your refund? If unsure, please call (800) 304-3107 * Yes No Did you or your family have Marketplace Health Insurance Form 1095A at any time in 2024? Visit healthcare.gov for more info. Call (800) 318-2596. * Yes No Income * Please select each type of income that you received for the 2024 Year. W2 Unemployment Income (1099G) Self Employment - 1099NEC/1099K/1099MISC Household Income (HOme Health/Nanny) Tuition Statement - 1098T Interest Income - 1099INT Alimony Other Deductions and Credits Which of the following applies to you? I paid a daycare or a nanny to care for my child 13 years or younger while I worked or looked for work. I can get a statement with their EIN/SSN to provide this claim. I attended a college/university/community college/post-secondary institution/career school and paid eligible expenses that can be proven with a 1098T form. I paid charity/tithes/or given donations to community organizaions and/or religious institutions. I paid over $12,400 in expenses for itemizing. I paid student loan interest and received a 1098E. I had eligible medical expenses. I had energy and solar power expenses. I sold and/or purchased a home. I adopted a child or had a baby. I am in the military and had to move. I got sepearated/divorced paid or received alimony. Refund Selection How would you like your refund? Paper check printed in office Direct deposit to my account Prepaid debit card Routing Number Account Number Thank you! Your answers have been submitted.
