Client Intake Form ✨

Type of Client

Tax Year *

Is This An Amendment? *

Yes

No

First Name

Last Name

Phone *

Email *

Social Security Number *

Date of birth *

Address

Street Address *

City *

State *

Country *

Postal Code *

Dependent #1

Dependent #1 SSN

Dependent #1 DOB

Relationship To Dependent (Dependent #1)

Dependent #2

Dependent #2 SSN

Dependent #2 DOB

Relationship To Dependent (Dependent #2)

Dependent #3

Dependent #3 SSN

Dependent #3 DOB

Relationship To Dependent (Dependent #3)

Is This A New Address With The IRS? *

Yes

No

Can Another Tax Payer Claim You As A Dependent On Their Taxes? *

Yes

No

Will You Be Filing A Return With Your Spouse ? *

Yes

No

Spouse Name

Spouse D.O.B

Spouse Social Security #

Spouse Email

Any Childcare Expenses For Dependents ? *

Yes

No

Did you , your spouse, or dependents attend college? *

Yes

No

Did You receive Health Insurance Through Marketplace ? *

Yes

No

If You are a homeowner , have you received form 1098 from your mortgage lender ? *

Yes

No

Are you self employed ? *

Yes

No

Do You Owe Any Government Agency ? *

Yes

No

IPPIN

Identification *

Bank Name *

Bank Account Number *

Bank Routing Number *

Verify Bank Account Number *

Verify Bank Routing Number *

Proof Of HOH/ Birth Certificates

Social Security Cards(Taxpayer & Dependents)

Tax Documents(1099,w2,1098-T , Etc)

Tax Documents(1099,w2,1098-T , Etc) (copy)

Tax Documents(1099,w2,1098-T , Etc) (copy) (copy)

Who Referred You?

Signature *

Clear

Date Signed *

Right to Debit Disclosure Description

If your tax refund does not fund for any reason—such as IRS or state rejection, offset, or audit—the full tax preparation fee is still due. By providing your bank account or card information, you authorize The Tax Collective to debit the account you supplied for any unpaid fees. This ensures that preparation costs are collected even if the refund is not received. You remain responsible for any fees associated with declined or returned debit attempts.

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