Client Intake Form

M-F: 9AM PST - 5PM PST

337-781-5053

Are You a Returning Client? *

If You Are A New Client, Upload Prior Year Tax Return

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 4 Files )

Tax Payer Name *

Tax Payer Phone # *

Tax Payer Date Of Birth *

Email *

Tax Payer Social Security Number *

Drivers License *

PNG, JPEG, JPG or GIF

Occupation

Spouse Name *

Spouse Social Security Number *

Spouse Date Of Birth *

Spouse Phone Number *

Spouse Email *

Filing Status *

Number Of Dependents

List All Your Dependents' Name, SSN, Date Of Birth, and Relationship *

If any of your dependents are disabled list them here

Payment Options *

Without fees from refund

Pay at time of filing

Bank Name *

Routing Number *

Account Number *

Type Of Account *

Please answer only if it applies to you.

If your address is different than the one thats on your government ID or drivers license, please indicate the reason why.

If applicable, please indicate why you are claiming a dependent that is not related to you. What are the circumstances that you have supported this dependent for at least 6 months of 2024. Please outline the support you have provided to this dependent.

Are all of the dependents being claimed related to the taxpayer by birth or bloodline? If not, please identify which child is not related to you?

Please answer if applicable, if your last name is different than your dependent's last names, that you are filing, what is the reason why? Please indicate the reason why there is a difference in the last names between you and your dependents.

Please answer, only if applicable: If your income is at or below $13,000.00 & you have 2 or more children, how are you able to maintain the household. For example, did you receive government assistance, as such as: section 8, public housing, SNAP benefits, or other.

If you are the father of the child and claiming the child. Please indicate the reason why the child is living with you and not the mother. Please outline the support you have provided to the child.

Financial Tax Documents (W2,1099,Unemployment,ect)

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 10 Files )

If you received a 1099G form for unemployment, please upload it here.

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 5 Files )

If you received a 1098T form for school, please upload here.

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 4 Files )

Do you need assistance with organizing your/side hustle business income & expenses?

Yes

No

Did you have a business in 2024? Includes 1099s, or side business. Ex. hair braiding, hair stylist, baby sitting, uber, lyft, door dashing, & etc. If so, what is the name & nature of your business or side business. If you don't have a name, you can bypass the name.

Did you purchase a vehicle recently?

Yes

No

If yes, please list the year make and model of the vehicle.

Tax Form Abandonment/Ach Agreement

Here at Qof business consulting llc. Unfulfilled Tax Quotes will result in a $150 Service Fee - If the client decides to file their tax return elsewhere. This fee will be processed through our payment merchant until fulfilled. If the client files their taxes with us, they will be charged the regular tax filing fees processed from the tax return per usual. No upfront fees - all fees will be cured from the tax return unless otherwise agreed due to intricate tax situations. Thank you - Qof business consulting llc.

Tax Payer Signature ( Must be legible)

Clear

Spouse Signature

Clear

Notes (anything you think we need to know)

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