ALL IN ONE INTAKE FORM 2024-2025

Taxpayer Name *

Taxpayer Email *

Taxpayer Date of birth

Taxpayer Phone *

Address

Street Address *

City

State

Country

Postal code

Occupation *

Taxpayer's Social Security Number *

Taxpayer Social Security Card

Social Security Card

Valid photo ID

Have you been issued an Identity Protection PIN?

Yes

No

Not sure

Yes, but I need assistance getting my IP PIN.

If Yes, Please enter your Identity Protection Pin

Filing Status (If head of household, upload lease or mortgage statement)

What tax year are you filing? You can e-file the past 3 years.

2024

2023

2022

2021

Are you a homeowner? *

Are you filing an eligible spouse on your tax return?

Yes

No

Spouse Full Name

Spouse Date of birth

Spouse Social Security Number

Spouse SSC

Spouse photo ID

What type of healthcare did you or dependents have?

Marketplace/ ObamaCare (1095-A required)

MedicAid or MediCare (1095-B)

Employer HealthCare (1095-C)

None

First Dependent Information

Dependent Name

Dependent Date of Birth

Dependent Social Security Number

Relationship of Dependent to Taxpayer

Dependent Social Security Cards

Dependent Birth Certificates

Second Dependent Information

Dependent Name

Dependent Date of Birth

Dependent Social Security Number

Relationship of Dependent to Taxpayer

Dependent Social Security Cards

Dependent Birth Certificates

Third Dependent Information

Dependent Name

Dependent Date of Birth

Dependent Social Security Number

Relationship of Dependent to Taxpayer

Dependent Social Security Cards

Dependent Birth Certificates

Fourth Dependent Information

Dependent Name

Dependent Date of Birth

Dependent Social Security Number

Relationship of Dependent to Taxpayer

Dependent Social Security Cards

Dependent Birth Certificates

Are you a college student or are you claiming a college student?

If yes, upload Form 1098-T.

Upload 1098T

Did you receive a Form 1095-A Health Insurance Marketplace Statement? (If you received a form 1095-B, 1095-C or had Medicare, it is not required to be entered in 2023)

Did you have any childcare expenses?

Yes

No

If yes please upload form 2441 (provided by daycare) or W10 form (Private childcare)

If yes please upload form 2441 or W10

Do you have rental property to report?

Yes

No

Are you an Airbnb host?

Yes

No

Are you or your spouse totally blind?

Yes, me.

Yes, my spouse.

No

Did you file taxes last year?

Yes, I received my full refund.

Yes, but I didn't receive my full refund.

No, I did not file my taxes.

If Yes Upload a copy of your 2024 tax return

Did you receive a 2024 state return?

Yes

No

Have you ever been disallowed Earned Income credit?

Yes

No

How would you like to receive your refund/advance?

Direct Deposit

Visa Cash Card

Check printed at the office

Are you applying for the Cash Advance Loan?

Yes up to $1000

Yes Up to $7000

No, I'll wait on my refund

Direct Deposit Info

Bank Name
Account Number
Account Name
Account type
Routing Number
Additional Info.

Note: Add Account Type Checking/Savings

Tax Payer Signature

Clear

Spouse Signature (If applicable)

Clear

Date

Are you a new client or a returning one?

New Client

Returning Client

What other services are you interested in:

ALL IN ONE INTAKE FORM 2024-2025

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