2025 Client Intake Questionnaire

Which Preparer Are You Working With? *

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

What tax year is this submission for? (Please do not attach documents that are not for the tax year you selected. If you need more than 1 year filed it needs to be submitted as a separate submission for each year. *

Is this an amendment? *

Yes

Are you requesting an Extension? *

Yes

Marital Status *

Client Filing Status *

Head of Household Supporting Document

Occupation *

First Name *

Last Name *

Taxpayer's Social Security # *

Taxpayer's Date of Birth *

Email *

Phone *

Street Address *

City

State

Country

Postal code

Is this a new address with the IRS? *

Yes

Are you a U.S Citizen? *

Yes

Can another taxpayer claim you as a dependent on their tax return? *

Yes

Are you totally and permanently disabled? *

Yes

Are You Legally Blind? *

Yes

Are you interested in an In Season Refund Advance? *

Yes

Upload a Recent & Clear Selfie. (Within the last 30 days) *

Upload a Recent & Clear Selfie. (Within the last 30 days)

Driver License/ State ID *

Driver License/ State ID

Tax Payer Social Security Card

Will you be filing a tax return with your spouse? *

Yes

Spouse Full Name

Spouse's Social Security Number

Spouse's Social Security Card

Dependents

Are You Claiming Any Dependents? *

Yes

How many Dependents are you claiming?

Dependent 1

Full Name
Date Of Birth
Social Security Number
Number Of Months Lived in Home of (Tax Filing Year)
Relationship Between You and Dependent

Dependent 2

Full Name
Date Of Birth
Social Security Number
Number Of Months Lived in Home of (Tax Filing Year)
Relationship Between You and Dependent

Dependent 3

Full Name
Date Of Birth
Social Security Number
Number Of Months Lived in Home of (Tax Filing Year)
Relationship Between You and Dependent

Dependent 4

Full Name
Date Of Birth
Social Security Number
Number Of Months Lived in Home of (Tax Filing Year)
Relationship Between You and Dependent

Upload All Dependent Social Security Cards

Did you pay any child care expenses for any dependents listed above? *

Yes

Who did you pay childcare expenses for?

Who did you pay?

How much did you pay?

Care Provider Address?

Did you receive health insurance through the Market Place? *

Yes

Upload MarketPlace 1095-A form.

If you own your home, have you received form any property documents from your mortgage lender? *

Yes

Upload Tax Property documents.

Did you or your spouse receive unemployment benefits ? *

Yes

Upload Unemployment Documents.

Are you, your spouse or any dependents college student? *

Yes

Did you or your spouse make payments on your student loans ? *

Yes

Upload School Related Documents.

Do you owe debt to any Government Agency; such as IRS, Student Loans, Child Support etc? *

Yes

Do you have an IRS IP PIN? *

Yes

IP PIN Number

Do you have a copy of your tax return from last year? *

Yes

Are you interested in Audit Protection for your tax return? ($79 Fee) *

Yes

Banking Information

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

If You Are Eligible For a Refund, How Would You Like It Disbursed? *

Direct Deposit

Printed Check ($35 to mail)

Prepaid Card ($35 to mail)

Bank Name

Account Number

Verify Account Number

Routing Number

Verify Routing number

Income

Employment Status *

Employed

Unemployed

Self-Employed

Please upload all relevant tax documents (W2, 1099, 1098-T, Etc):

General Expenses

Upload expense evidence here:

Are you Filing a State Return? *

Yes

Authorization & Consent

I confirm that all information I entered here is accurate and true.
I allow you to capture my sensitive data like personal ID, government ID, Social Security Number (SSN), and other information.
I have read the terms and conditions and privacy policy.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.

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].

Who Referred You to Me? *

Anything you'd like us to know when preparing your return? *

Client Signature (Electronic Signature Accepted)

Clear

Print Full Name (as signed above)

Spouse Signature (If Applicable)

Clear

Date *

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from WealthCrest Financial. Message frequency varies. Message & data rates may apply.