2025 Client Intake Questionnaire

Which Preparer Are You Working With?
  • Denise O'Neal
  • Eishu Agarwal
  • Heather Riley
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NOTICE: ALL income statements, social security cards and/or state issued ID are required for this submission. Your file is subject to delays and/or cancellation if the required documents aren't attached. Attach ALL of your documents to this form DO NOT EMAIL documents. We will send a secure link for any additional documents. Thank you.

TaxPayer Information

  • 2025
  • 2024
  • 2023
  • 2022
  • 2021
  • 2020
  • 2019
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Marital Status
  • Never Married
  • Married
  • Divorced
  • Legally Separated
  • Widowed
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Client Filing Status
  • Single
  • Married Filing Jointly
  • Married Filing Separately
  • Qualified Widower
  • Head of Household
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Country
  • Afghanistan
  • Albania
  • Algeria
  • American Samoa
  • Andorra
  • Angola
  • Anguilla
  • Antarctica
  • Antigua and Barbuda
  • Argentina
  • Armenia
  • Aruba
  • Australia
  • Austria
  • Azerbaijan
  • Bahamas
  • Bahrain
  • Bangladesh
  • Barbados
  • Belarus
  • Belgium
  • Belize
  • Benin
  • Bermuda
  • Bhutan
  • Bolivia
  • Bosnia and Herzegovina
  • Botswana
  • Bouvet Island
  • Brazil
  • British Indian Ocean Territory
  • Brunei Darussalam
  • Bulgaria
  • Burkina Faso
  • Burundi
  • Cambodia
  • Cameroon
  • Canada
  • Cape Verde
  • Cayman Islands
  • Central African Republic
  • Chad
  • Chile
  • China
  • Christmas Island
  • Cocos (Keeling) Islands
  • Colombia
  • Comoros
  • Congo
  • Congo, The Democratic Republic of the
  • Cook Islands
  • Costa Rica
  • Cote D"Ivoire
  • Croatia
  • Cuba
  • Cyprus
  • Czech Republic
  • Denmark
  • Djibouti
  • Dominica
  • Dominican Republic
  • Ecuador
  • Egypt
  • El Salvador
  • Equatorial Guinea
  • Eritrea
  • Estonia
  • Ethiopia
  • Falkland Islands (Malvinas)
  • Faroe Islands
  • Fiji
  • Finland
  • France
  • French Guiana
  • French Polynesia
  • French Southern Territories
  • Gabon
  • Gambia
  • Georgia
  • Germany
  • Ghana
  • Gibraltar
  • Greece
  • Greenland
  • Grenada
  • Guadeloupe
  • Guam
  • Guatemala
  • Guernsey
  • Guinea
  • Guinea-Bissau
  • Guyana
  • Haiti
  • Heard Island and McDonald Islands
  • Holy See (Vatican City State)
  • Honduras
  • Hong Kong
  • Hungary
  • Iceland
  • India
  • Indonesia
  • Iran, Islamic Republic Of
  • Iraq
  • Ireland
  • Isle of Man
  • Israel
  • Italy
  • Jamaica
  • Japan
  • Jersey
  • Jordan
  • Kazakhstan
  • Kenya
  • Kiribati
  • Korea People's Democratic Republic
  • Republic of Korea
  • Kuwait
  • Kyrgyzstan
  • Land Islands
  • Lao People's Democratic Republic
  • Latvia
  • Lebanon
  • Lesotho
  • Liberia
  • Libyan Arab Jamahiriya
  • Liechtenstein
  • Lithuania
  • Luxembourg
  • Macao
  • North Macedonia
  • Madagascar
  • Malawi
  • Malaysia
  • Maldives
  • Mali
  • Malta
  • Marshall Islands
  • Martinique
  • Mauritania
  • Mauritius
  • Mayotte
  • Mexico
  • Federated States of Micronesia
  • Moldova, Republic of
  • Monaco
  • Mongolia
  • Montenegro
  • Montserrat
  • Morocco
  • Mozambique
  • Myanmar
  • Namibia
  • Nauru
  • Nepal
  • Netherlands
  • New Caledonia
  • New Zealand
  • Nicaragua
  • Niger
  • Nigeria
  • Niue
  • Norfolk Island
  • Northern Mariana Islands
  • Norway
  • Oman
  • Pakistan
  • Palau
  • Palestinian Territory, Occupied
  • Panama
  • Papua New Guinea
  • Paraguay
  • Peru
  • Philippines
  • Pitcairn
  • Poland
  • Portugal
  • Puerto Rico
  • Qatar
  • Reunion
  • Romania
  • Russian Federation
  • Rwanda
  • Saint Helena
  • Saint Kitts and Nevis
  • Saint Lucia
  • Saint Pierre and Miquelon
  • Saint Vincent and the Grenadines
  • Samoa
  • San Marino
  • Sao Tome and Principe
  • Saudi Arabia
  • Senegal
  • Serbia
  • Seychelles
  • Sierra Leone
  • Singapore
  • Slovakia
  • Slovenia
  • Solomon Islands
  • Somalia
  • South Africa
  • South Georgia and the South Sandwich Islands
  • Spain
  • Sri Lanka
  • Sudan
  • Suriname
  • Svalbard and Jan Mayen
  • Eswatini
  • Sweden
  • Switzerland
  • Syrian Arab Republic
  • Taiwan
  • Tajikistan
  • Tanzania, United Republic of
  • Thailand
  • Timor-Leste
  • Togo
  • Tokelau
  • Tonga
  • Trinidad and Tobago
  • Tunisia
  • Turkey
  • Turkmenistan
  • Turks and Caicos Islands
  • Tuvalu
  • Uganda
  • UK
  • Ukraine
  • United Arab Emirates
  • United States
  • United States Minor Outlying Islands
  • Uruguay
  • Uzbekistan
  • Vanuatu
  • Venezuela
  • Vietnam
  • Virgin Islands, British
  • Virgin Islands, U.S.
  • Wallis and Futuna
  • Western Sahara
  • Yemen
  • Zambia
  • Zimbabwe
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Dependents

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
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Banking Information

PLEASE PUT ACCOUNT AND ROUTING NUMBER IN TWICE TO MAKE SURE WE HAVE THE CORRECT NUMBERS


Income

General Expenses

Authorization & Consent

Letter of Engagement

Thank you for choosing WealthCrest Financial to assist with the preparation of your income tax returns. To ensure a clear understanding of our professional relationship, please review the following information carefully.

We will prepare your tax returns based solely on the information you provide to us. Upon completion, any original tax documents will be returned to you. While we may retain scanned copies of your documents for our records, it is your responsibility to keep all original documents, canceled checks, and any other records that substantiate your income, deductions, and tax return data. These documents may include, but are not limited to, records supporting deductions for meals, entertainment, travel, business gifts, charitable contributions, and vehicle use (if applicable), as well as bank and credit card statements. Retaining these records is critical for verifying the accuracy and completeness of your returns in the event of an audit or review by tax authorities. We recommend you maintain all relevant documents and copies of your tax returns for at least five years from the filing date or the returns’ due date, whichever is later.

Please note that our role in preparing your tax returns does not include identifying errors, irregularities, or illegal activities, such as fraud, within the information you provide. We will exercise professional judgment in addressing any areas where the tax law may be ambiguous or where differing interpretations exist. Unless directed otherwise by you, we will take a reasonable tax position in your favor when possible. However, we cannot guarantee that these positions will not be challenged by tax authorities or predict the outcome of such challenges. Additionally, we are not responsible for any issues that arise due to omitted or incomplete income, expenses, or other information not provided to us during the tax preparation process or before your returns are filed.

Thank you for trusting WealthCrest Financial with your tax needs. We value the opportunity to work with you and look forward to assisting you.

CONSENT TO USE OF TAX RETURN INFORMATION

For the purposes of this consent form, “we,” “us,” and “our” refer to WealthCrest Financial. Federal law requires us to provide this consent form to you. Unless authorized by law, we cannot use your tax return information for purposes other than the preparation and filing of your tax return without your explicit consent. Completing this form is not mandatory for engaging our tax preparation services.

If this form is signed under the condition that our tax preparation services depend on your consent, the consent will not be valid. Your consent will remain valid for the duration you specify. If no duration is specified, your consent will remain valid for one year from the date of your signature. Declining to consent does not affect your ability to have your tax return prepared and electronically filed by WealthCrest Financial for a fee.

For your convenience, WealthCrest Financial may work with third-party providers to offer qualifying taxpayers the opportunity to apply for Electronic Refund Disbursement Services and/or Loan products. To determine if you qualify for these products, we may need to use your tax return information to calculate the amount of your anticipated refund.

By signing below, you authorize WealthCrest Financial to use the tax return information you provide for the preparation of your tax return, solely to determine your eligibility for these products and services.

If you believe your tax return information has been disclosed or used improperly in a way not authorized by law or without your consent, you may contact the Treasury Inspector General for Tax Administration (TIGTA) at 1-800-366-4484 or by email at [email protected].

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