TAX PREP CLIENT INTAKE FORM

Filing Status *

TAXPAYER INFORMATION:

Full Name *

Date of birth *

Phone *

Email *

Address

Street Address *

City

State

Postal code

Occupation *

Are you a full-time student? *

Yes

No

Are you totally and permanently disabled? *

Yes

No

Are you legally blind?

Yes

No

Spouse Information

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 and permanently disabled?

Yes

No

Are they legally blind?

Yes

No

Are they your dependent?

Yes

No

DEPENDANTS:

Enter your dependents here

Name
Name
Name
Name
Name

TAX RELATED QUESTIONS:

Employment Status *

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

Yes

No

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

Yes

No

Are you currently renting?

Yes

No

What is the monthly rental amount?

GENERAL EXPENSES:

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

ACKNOWLEDGMENT & SIGNATURE

I confirmed that all information I entered here is accurate and true.
I allow Luxx Credit and Tax Services 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 of
Luxx Credit and Tax Services.
By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this 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.