New Tax Customer Intake Form

Subject *

Primary Tax Payer Name: *

Complete Address: *

Phone Number: *

Can we send text messages? *

Your Email *

Social Security Number: *

Date of Birth: *

Driver's License or Identification Number: *

State Issued: *

Current Occupation: *

Employment Status: *

Drop Down Menu - *If you are unsure , please visit the following website for an explanation: https://www.bamboohr.com/resources/hr-glossary/employment-status

Mother Maiden Name: *

Filing Status: * *

Spouse Information

Spouse Name:

Spouse Complete Address (if different):

Spouse Phone Number:

Can we send text messages?

Spouse Email:

Spouse Social Security Number:

Spouse Date of Birth:

Spouse Drivers License or Identification Number:

Spouse State Issued:

Spouse Mother's Maiden Name:

Spouse Current Occupation:

Spouse Employment Status:

Drop Down Menu - If you are unsure, please visit the following website for an explanation: https://www.bamboohr.com/resources/hr-glossary/employment-status

Are you or your spouse over 65 years old? *

YES

NO

Dependent Information

List ALL your Dependents Full Name, Date of Birth, Social Security Number & Relationship *

Dependent Questions:

This person was over age 18 and a full-time student at an eligible educational institution.

Check if this person was DISABLED.

Check if this qualifying child is NOT YOUR DEPENDENT

Check if you wish to NOT claim this dependent for Earned Income Credit purposes

Check if this dependent is married.

This individual made over $5,050 of income

This dependent qualifies for a Multiple Support Declaration. (See Below)

NONE (Choose if none of the above statements apply)

These questions apply to ALL of your dependents, so if You answer YES to any question, please put the question you answered YES to in the note section along with dependents name the question applies to.

Multiple Support Declaration

Did you have health insurance all 12 month of the year? *

Did you have Marketplace or Obamacare Insurance? *

Requires Form 1095-A - Contact Healthcare.gov at (800) 318-2596 or Login to your account at www.https://www.healthcare.gov/

Type of Return: *

Drop Down Menu

What state are you filing for?

If you are filing for multiple states, please include ALL states

What state are you filing for?

If you are filing for multiple states, please include ALL states

Other Possible Credits: *

Large Medical Expenses (Might want to consider Itemize)

Paid Any Mortgage Interest?

Paid any Vehicle Tax (Include Receipt)

Filed an Extension (with Payment)

Did you make any Federal Tax Payments this year (exclude those withheld from your check)?

Did you make any State Tax Payments this year (exclude those withheld from your check)?

NONE (Choose if none of the above statements apply)

Federal Tax Payment Amount:

Previous payments made to the IRS in the same years filed or overage from a previous year.

State Tax Payment Amount:

Previous payments made to the IRS in the same years filed or overage from a previous year.

Have you been a Victim of Identity Theft in the PAST year? *

Drop down menu

Does the IRS require a PIN to file your taxes?

Drop down menu - If you have put fraud protection on your IRS file, a pin number will be required to file your taxes. For more information please visit: https://www.irs.gov/identity-theft-fraud-scams/get-an-identity-protection-pin

Additional Information:

LOAN ADVANCE - Do you want to apply for an advance? *

Drop down menu - DISCLAIMER: Loan advances are available up to $5000. Loan from $250 to $1000 are NO FEE. Loans greater than $1000 will have finance charges. Loan information will be included in the tax return package.

Advance Amount Applying for:

Loan advances are available up to $5000. Loan from $250 to $1000 are NO FEE. Loans greater than $1000 will have finance charges. Loan information will be included in the tax return package.

Optional Products *

Defend My ID - $29.99 - Discounted

Audit Maintenance Pro - $42.00 Discounted

Both

Not Interested

In this world of uncertainty and their, consider the following products: Defend MY ID is a Identity Theft Protection program, more information is available on there website. Visit https://defendmyid.com/. Audit Maintenance Pro provides protection for up to 3 years if you get audited on your tax return. More information is available on their website. Visit

https://auditmp.com/. These are optional products provided by a 3rd party and in no way affiliated with Paragon Parcel Companies LLC.

Upload Current Driver's License or Identification: *

Upload Social Security Card: *

Upload your W-2, 1099, other proof of Income: *

Upload Spouse Current Driver's License or Identification:

Upload Secure Social Security Card:

Upload your Spouse W-2, 1099, other proof of Income:

Upload Dependents Identification, (including Birth Certificates):

Upload Dependents Social Security Cards

More than 4 Dependents

How did you hear about us? *

If Other, Please list:

How are you paying Tax Preparation fees? *

Fees may vary depending on your tax situation. If you select upfront, payment is required before refund is filed with the IRS. If you select Deduct from refund the bank does charge an additional fee of $39.95.

Electronic Signature (Type Your Full Name): *

By typing your full name you agree that your electronic signature is legally equivalent to your manual or handwritten signature on this document.

Spouse Electronic Signature (Type Your Full Name):

By typing your full name you agree that your electronic signature is legally equivalent to your manual or handwritten signature on this document.

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New Tax Customer Intake Form

Please complete this form to the best of your ability.

Pay special attention to the area that have the (*) star next to them

If you come across a section that does not apply to you, please, mark N/A or the form will not let you continue.

These questions are based on the tax year we are currently filing for. If your circumstances changed in January and beyond of the current year DO NOT include that.

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New Tax Customer Intake Form

Please complete this form to the best of your ability.

Pay special attention to the area that have the (*) star next to them

If you come across a section that does not apply to you, please, mark N/A or the form will not let you continue.

These questions are based on the tax year we are currently filing for. If your circumstances changed in January and beyond of the current year DO NOT include that.