Complete your Tax

Intake online!

Complete Your Tax Intake Online!

Let's Start Your Taxes

Please complete using your name, spouse’s name, and dependent(s) as it is written on your social security card. IF you have a different name than what appears on your card, please indicate the reason for the change (I.E. Marriage, Divorce)

You must complete this entire form in order for us to process you!

First we will start with your personal information.

First Name *

Middle Initial *

Last Name *

Phone *

Email *

Date of birth *

Social Security Number *

Do you own a business? *

Spouse's information

Please leave blank and continue to hit next till it asks for your address information if you are single or divorced.

Spouse's Full Name

Spouse's Phone Number

Spouse's Email

Spouse's Date of Birth

Spouse's Driver's License

License or Government ID

Spouse's Social Security Number

Home Address

Let's make sure we have the right home address on file for you.

Street Address *

City *

State *

Zip code *

DEPENDENT(S) if applicable

We have left space for up to 3. We will follow up with you if you mention that you have more after submitting. Again please leave blank and click next if you have no dependents.

Dependent 1 Name

Dependent 1 Relation

Dependent 1 Gender

Dependent 1 Date of Birth

Dependent 1 SSN

Dependent 1 Social Card

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Dependent 2 Name

Dependent 2 Relation

Dependent 2 Gender

Dependent 2 Date of Birth

Dependent 2 SSN

Dependent 2 Social Card

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Dependent 3 Name

Dependent 3 Relation

Dependent 3 Gender

Dependent 3 Date of Birth

Dependent 3 SSN

Dependent 3 Social Card

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A little more about you...

Answer the following by selecting the correct option in the drop down provided.

Are you a previous client? *

Did you file with us last tax season? *

Filing Status *

How many jobs did you work last year? *

Are you a student? *

IF so, can anybody else claim you as a dependent?

Did you have healthcare coverage? *

IF so, did you receive a 1095A?

Do you have IRS/State debt obligations? *

Any earned income disallowed? *

Do you wish to receive Audit Protection Coverage? ($125 additional filing fee) *

Are you applying for the TAX ADVANCE LOAN? *

Chose method of payment: *

IF direct deposit, PLEASE submit the following:

Bank Name

Routing Number

Account Number

Did anyone refer you to us? *

Name of Referrer (if applicable)

Please use this next section to upload a copy of the required documents to complete your filing process:

Government ID *

Social Security Card *

W2, 1099, or Last Paystub *

1095 A

Medical if you have

Any Additional Tax Document

ACKNOWLEDGEMENT OF SERVICES CONSENT

I HAVE ALLOWED HEAD START TAX SERVICE TO PREPARE MY FEDERAL AND STATE TAX RETURN. ALL DOCUMENTATION GIVEN BY ME TO HEAD START TAX SERVICE TO PERFORM ITS SERVICES IS TRUE AND ACCURATE INFORMATION. I HAVE BEEN PROVIDED THE PROPER KNOWLEDGE AND INFORMATION IN REFERENCE TO MY TAX RETURN. I FULLY UNDERSTAND THE FEES THAT I HAVE BEEN CHARGED, THE PROCESSING TIME IN WHICH IT TAKES TO RECEIVE MY RETURN, THE FEDERAL AND STATE GUIDELINES IN WHICH THIS OFFICE MUST OPERATE UNDER THAT HAS BEEN SET FORTH AND MANDATED BY THE GOVERNMENT, AND THAT ALL RETURNS ARE BASED UPON IRS APPROVAL.

I HAVE SIGNED AND RECEIVED A COPY OF MY FEDERAL AND STATE RETURN. I HAVE BEEN PROVIDED WITH PROPER CONTACT INFORMATION IF I SHOULD HAVE ANY FURTHER QUESTIONS OR CONCERNS ABOUT MY TAX RETURN.

Signature *

Clear

Consent *

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Contact

info@headstartbiz.com

Contact

info@headstartbiz.com

757-993-4334