Intake | EXACT TAX USA

Primary Client Information

About you — the person filing.

Full Legal Name *

SSN / ITIN *

Date of Birth *

Occupation

Email *

Phone *

Street Address *

City *

State *

ZIP *

Filing Status *

Determined with your preparer.

Can someone claim you as a dependent? *

Spouse Information

Only if Married Filing Jointly.

Spouse Full Name

Spouse SSN / ITIN

Spouse Date of Birth

Spouse Occupation

Dependents

List all dependents claimed on your return.

Dependents

One per line: Name, SSN/ITIN, Date of Birth, Relationship, Months lived in your home during the year.

Direct Deposit

For fastest refund delivery. Leave blank for a paper check.

Bank Name

Routing Number

Account Number

Account Type

Income Sources

Estimate amounts — exact figures come from your documents.

W-2 Wages

Self-Employment / 1099

Investment (interest/dividends)

Retirement / Pension

Unemployment

Other Income

Other Income Description

Due Diligence Questions

Required for credits such as EITC, Child Tax Credit, AOTC, and Head of Household.

These questions help us verify your eligibility under IRS paid-preparer due diligence rules (Form 8867). Answer to the best of your knowledge — we'll confirm details with you.

Did you live in the US more than half the year? *

Have you claimed EITC before?

Qualifying children for EITC

Did the qualifying child live with you over half the year?

Did you pay for childcare to work?

Childcare amount paid

Childcare provider name

Provider EIN / SSN

Did you pay higher education expenses?

Student loan interest paid

Did you have health coverage all year?

Did anyone in your household have Marketplace (1095-A) coverage?

Did you sell/trade cryptocurrency or digital assets?

Additional Notes

Anything else we should know?

Consent & Signature

Required to proceed.

I authorize EXACT TAX USA to e-file my federal and state tax return(s) on my behalf.I authorize EXACT TAX USA as my paid tax preparer and confirm the information provided is true and correct to the best of my knowledge.I acknowledge the Privacy Notice and consent to the secure handling of my personal and financial information.

Signature (type full name) *

Date *

Client Intake Form

Primary Client Information

Spouse Information

Dependents

Direct Deposit

Income Sources

Due Diligence Questions

Additional Notes

Consent & Signature