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Client Intake Information
[__CLICK HERE if you've completed the Intake Form previously and want to continue to the rest of the Forms__]

Name:  Tax Year: 
Address:  Phone: 
Evening Phone: 

Filing Status (check one)
     Single...................................................................
     Married...............................................................
     Married filing Separate.........................................
     Head of Household..............................................




 
This Area for Tax Preparer Use Only

_  Check Off Questionnaire Below     

  1-Return Prepared..................

 

  2-Print Return-Extra $5 Fee...

 

  3-E-mail Return-No Charge...

 

  4-Scan All Documents............

 

  5-Sign PIN (+EIC)..................

 
  6-Collect Payment...................
 
  7-Scan PIN (+EIC).................
 

  8-Post Payment on Bill Screen

 

  9-Note Payment on Client Bill

 
10-Set CSM to Complete.........
 

11-Archive...............................

 

12-E-mail Client Set + All Docs

 

Preparer # _______

               Last Year            
Fed _______________I
State ______________i
Bill $_______________
Adj $_______________
MT EC _____________


DIRECT DEPOSIT INFO PLEASE:
Bank Name:   
Bank Routing: 
Account No:   
Account Type:   Checking:     Savings:
Please answer with Yes or No or a number please ...  
Are You a Returning Client?.......................................
# of Children you Claim..............................................
Custodial Parent for ALL Claimed?............................
Can you Claim anyone else?.......................................
Are YOU Claimed by Someone Else?........................
How Many W-2s?.....................................................
How Many 1099s?....................................................
Did you receive a 1099-C for Cancellation of Debt?...
Any Mortgage Interest?..............................................
Are You a Student?....................................................
Did You Pay School Tuition?......................................
Did You Receive Unemployment?..............................
Any Bank Interest Income?........................................
Any Stock Dividend Income?.....................................
Any Social Security Income?......................................
Any Day Care Costs?................................................
Do You Have a Retirement Plan?...............................
Withdraw from a Retirement Plan?..............................
Why did you withdraw from Retirement?  
Did you start a business or purchase a business?..........
Any Other Income?....................................................
 If yes, what kind of income (business, hobby, gambling, prizes)?  
   
   

The undersigned guarantees that all information provided to Gregory's Tax and Bookkeeping Service for the purpose of preparing income tax returns is true and accurate.  This also constitutes a contract with Gregory's Tax and Bookkeeping Service for the purpose of preparing income tax returns and the undersigned agrees to be responsible for all charges incurred in that process.


 your email address:           

 

Signature ___________________________________________            Date _____________

 

Please email this form, signing with your email address   -OR- 

Print this Page, Sign and Bring with you to your appointment!!