TAX PREP CLIENT INTAKE FORM

TAXPAYER INFORMATION:

First Name *

Middle Name

Last Name *

Address *

Street Address *

City

State *

Country *

Postal code *

Have you lived in multiple state in the last year?

Yes

No

Enter previous location *

Street Address
City
State/Province
Postal/Zip Code

Date of birth *

Enter Social Security Number *

Phone *

Email *

Occupation *

Upload Identification *

Upload Identification

TAX FILING INFORMATION:

Are you a full-time student?

Yes

No

Are you legally blind?

Yes

No

Are you totally or permanently disabled?

Yes

No

RENTING INFORMATION:

Are you currently renting?

Yes

No

What is the monthly rental amount?

Landlords Name

Landlord Address *

Street Address
City
State/Province
Postal/Zip Code

DEPENDENT INFORMATION:

Do you have any dependents?

Yes

No

How many dependents do you have?

Dependent 1 Full Name

Dependent 1 (DOB)

Dependent 1 Gender

Male

Female

Dependent 1 Social Security Number *

Dependent 2 Full Name

Dependent 2 (DOB)

Dependent 2 Gender

Male

Female

Dependent 2 Social Security Number

Dependent 3 Full Name

Dependent 3 (DOB)

Dependent 3 Gender

Male

Female

Dependent 3 Social Security Number

Dependent 4 Full Name

Dependent 4 (DOB)

Dependent 4 Gender

Male

Female

Dependent 4 Social Security Number

Dependent 5 Full Name

Dependent 5 (DOB)

Dependent 5 Gender

Male

Female

Dependent 5 Social Security Number

SPOUSAL INFORMATION

Do you have spousal information to provide?

Yes

No

Spouse Full Name *

Spouse Date Of Birth *

Phone Number *

Email Address *

Address *

Street Address
City
State/Province
Postal/Zip Code

Spouse Occupation

Are they a full-time student?

Yes

No

Are they totally or permanently disabled?

Yes

No

Are they legally blind?

Yes

No

TAX RELATED QUESTIONS:

Employment Status

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

Yes

No

Is this your first time opening a pre-tax account?

Yes

No

GENERAL EXPENSES:

Do you have any expenses you would like to add?

Yes

No

Enter the following expenses total amount

Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses

Total Expenses

Documents Upload

Do you have a W2?

Yes

No

Upload W2

Upload income documents

Were any of your wages on your W-2 for overtime (OT)?

Yes

No

How much OT total?

Do you have business income?

Yes

No

Please upload supporting business documents

Expense & Deduction Documents

Please provide a copy of last year's tax return

Last year's tax return

Do you have a 1099-G/R/SSA/NEC/MISC form?

Identification Documents

Do you have a 1099-INT/DIV form?

Identification Documents

Do you have any school forms?

Yes

No

Upload school forms

Do you have any other forms to upload?

Yes

No

Upload documents

Do you require an IP PIN number?

Yes

No

Please enter your IP pin number

ACKNOWLEDGMENT & SIGNATURE

I hereby certify that all information provided by me is true, correct, and complete to the best of my knowledge. I expressly authorize Cherry Tax Services to collect, use, store, and transmit sensitive personal information, including government-issued identification and Social Security numbers (SSNs), as necessary for tax preparation and related services.

I acknowledge that I have read, understood, and agreed to the Terms and Conditions and Privacy Policy of Cherry Tax Services. By signing below, I affirm that I understand and accept my responsibilities, as well as the responsibilities of Cherry Tax Services in connection with the preparation and filing of my tax return.

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.