Income Tax Intake | EconomyTax.biz

Income Tax Intake Form

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Yes, I am just uploading documents to go with the form I have already submitted

No, I am completing the form for the first time.

Primary Taxpayer Information

Please Note that you can "Save and Continue" this form later by using the link at the bottom of the page next to the "Submit" button.

Primary Taxpayer Name*

Prefix First Middle Last Suffix

Email*

Enter Email Confirm Email

Date of Birth*

SS#*

Driver's License # or Official ID #*

ID Issue Date*

ID Expiration Date*

Occupation*

Passcode*

Please set a 4-6 digit passcode that we can use to identify you. Please keep this passcode confidential.

Please Answer the Following

Did Economy Tax prepare your last return?*

Yes

How did you learn of Economy Tax?

Where did you file your prior year return?*

Has a copy of prior year return been provided to Economy Tax?*

Yes

Please upload a copy of last year's return

Drop files here or

Max. file size: 128 MB.

Have you had any tax return issues in the past 3 years?*

Yes

Please Explain*

If you receive a refund, do you want to use direct deposit?*

Yes

9-Digit Routing Number*

Bank Account Number*

Were you married on December 31st?*

Yes

Were you living together in July?*

Yes

Spouse

Spouse's Name*

Prefix First Middle Last Suffix

Email*

Enter Email Confirm Email

Date of Birth*

SS#*

Driver's License or Official ID*

ID Issue Date*

ID Expiration Date*

Occupation*

Personal Information

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Spouse's Home Phone

Your Cell Phone*

Spouse's Cell Phone

Your Work Phone*

Spouse's Work Phone

Household

Please list everyone living at your address, including yourself.*

Please add one person per line. Press the "+" to add another line.

First Name

Last Name

How many dependents are you claiming?*

Dependent 1

Name*

First Last

SS#*

Date of Birth*

Does Dependent 1 attend daycare or before/after school care?*

Yes

Name of care provider / institution:*

Is Dependent 1 a student? (elementary, middle, high school, college)?*

Yes

School Name*

Is Dependent 1 disabled?*

Disabled is defined as they are on a disability program.

Yes

Official Documentation for disabled dependents*

You must provide official documentation PRIOR to electronically submitting a return. Examples of documentation may include, but not be limited to, the following: Disability Letter from Doctor (will be verified), Notice from Social Security Administration, Immobility Card with Photo ID, etc.

Drop files here or

Max. file size: 128 MB.

Did the dependent reside with you for at least 6 months this past year?*

Yes

Dependent 1’s relationship to you*

Please upload Proof / Court Documents*

Drop files here or

Max. file size: 128 MB.

Who are the Biological Parents?

Biological Mother's Name*

First Middle Last

Biological Father's Name*

First Middle Last

Dependent 2

Name*

First Last

SS#*

Date of Birth*

Does Dependent 2 attend daycare or before/after school care?*

Yes

Name of care provider / institution:*

Is Dependent 2 a student? (elementary, middle, high school, college)?*

Yes

School Name*

Is Dependent 2 disabled?*

Disabled is defined as they are on a disability program.

Yes

Official Documentation for disabled dependents*

Drop files here or

Max. file size: 128 MB.

Did the dependent reside with you for at least 6 months this past year?*

Yes

Dependent 2’s relationship to you*

Please upload Proof / Court Documents*

Drop files here or

Max. file size: 128 MB.

Who are the Biological Parents?

Biological Mother's Name*

First Middle Last

Biological Father's Name*

First Middle Last

Dependent 3

Name*

First Last

SS#*

Date of Birth*

Does Dependent 3 attend daycare or before/after school care?*

Yes

Name of care provider / institution:*

Is Dependent 3 a student? (elementary, middle, high school, college)?*

Yes

School Name*

Is Dependent 3 disabled?*

Disabled is defined as they are on a disability program.

Yes

Official Documentation for disabled dependents*

Drop files here or

Max. file size: 128 MB.

Did the dependent reside with you for at least 6 months this past year?*

Yes

Dependent 3’s relationship to you*

Please upload Proof / Court Documents*

Drop files here or

Max. file size: 128 MB.

Who are the Biological Parents?

Biological Mother's Name*

First Middle Last

Biological Father's Name*

First Middle Last

Dependent 4

Name*

First Last

SS#*

Date of Birth*

Does Dependent 4 attend daycare or before/after school care?*

Yes

Name of care provider / institution:*

Is Dependent 4 a student? (elementary, middle, high school, college)?*

Yes

School Name*

Is Dependent 4 disabled?*

Disabled is defined as they are on a disability program.

Yes

Official Documentation for disabled dependents*

Drop files here or

Max. file size: 128 MB.

Did the dependent reside with you for at least 6 months this past year?*

Yes

Dependent 4’s relationship to you*

Please upload Proof / Court Documents*

Drop files here or

Max. file size: 128 MB.

Who are the Biological Parents?

Biological Mother's Name*

First Middle Last

Biological Father's Name*

First Middle Last

Dependent 5

Name*

First Last

SS#*

Date of Birth*

Does Dependent 5 attend daycare or before/after school care?*

Yes

Name of care provider / institution:*

Is Dependent 5 a student? (elementary, middle, high school, college)?*

Yes

School Name*

Is Dependent 5 disabled?*

Disabled is defined as they are on a disability program.

Yes

Official Documentation for disabled dependents*

Drop files here or

Max. file size: 128 MB.

Did the dependent reside with you for at least 6 months this past year?*

Yes

Dependent 5’s relationship to you*

Please upload Proof / Court Documents*

Drop files here or

Max. file size: 128 MB.

Who are the Biological Parents?

Biological Mother's Name*

First Middle Last

Biological Father's Name*

First Middle Last

Dependent 6

Name*

First Last

SS#*

Date of Birth*

Does Dependent 6 attend daycare or before/after school care?*

Yes

Name of care provider / institution:*

Is Dependent 6 a student? (elementary, middle, high school, college)?*

Yes

School Name*

Is Dependent 6 disabled?*

Disabled is defined as they are on a disability program.

Yes

Official Documentation for disabled dependents*

Drop files here or

Max. file size: 128 MB.

Did the dependent reside with you for at least 6 months this past year?*

Yes

Dependent 6’s relationship to you*

Please upload Proof / Court Documents*

Drop files here or

Max. file size: 128 MB.

Who are the Biological Parents?

Biological Mother's Name*

First Middle Last

Biological Father's Name*

First Middle Last

Dependent 7

Name*

First Last

SS#*

Date of Birth*

Does Dependent 7 attend daycare or before/after school care?*

Yes

Name of care provider / institution:*

Is Dependent 7 a student? (elementary, middle, high school, college)?*

Yes

School Name*

Is Dependent 7 disabled?*

Disabled is defined as they are on a disability program.

Yes

Official Documentation for disabled dependents*

Drop files here or

Max. file size: 128 MB.

Did the dependent reside with you for at least 6 months this past year?*

Yes

Dependent 7’s relationship to you*

Please upload Proof / Court Documents*

Drop files here or

Max. file size: 128 MB.

Who are the Biological Parents?

Biological Mother's Name*

First Middle Last

Biological Father's Name*

First Middle Last

Dependent 8

Name*

First Last

SS#*

Date of Birth*

Does Dependent 8 attend daycare or before/after school care?*

Yes

Name of care provider / institution:*

Is Dependent 8 a student? (elementary, middle, high school, college)?*

Yes

School Name*

Is Dependent 8 disabled?*

Disabled is defined as they are on a disability program.

Yes

Official Documentation for disabled dependents*

Drop files here or

Max. file size: 128 MB.

Did the dependent reside with you for at least 6 months this past year?*

Yes

Dependent 8’s relationship to you*

Please upload Proof / Court Documents*

Drop files here or

Max. file size: 128 MB.

Who are the Biological Parents?

Biological Mother's Name*

First Middle Last

Biological Father's Name*

First Middle Last

Dependent 9

Name*

First Last

SS#*

Date of Birth*

Does Dependent 9 attend daycare or before/after school care?*

Yes

Name of care provider / institution:*

Is Dependent 9 a student? (elementary, middle, high school, college)?*

Yes

School Name*

Is Dependent 9 disabled?*

Disabled is defined as they are on a disability program.

Yes

Official Documentation for disabled dependents*

Drop files here or

Max. file size: 128 MB.

Did the dependent reside with you for at least 6 months this past year?*

Yes

Dependent 9’s relationship to you*

Please upload Proof / Court Documents*

Drop files here or

Max. file size: 128 MB.

Who are the Biological Parents?

Biological Mother's Name*

First Middle Last

Biological Father's Name*

First Middle Last

Document Uploads

Please enter your tax payer information above before uploading documents.

You have not submitted a completed form. Please complete the entire intake form once before uploading additional documents.

Please upload all files here*

Please upload your driver’s license, any birth certificates, W-2s, 1099s, mortgage statements, proof of residency, etc.

Drop files here or

Max. file size: 128 MB.

Accuracy Acknowledgment

Disclosures - “All” Situations

Consent is sought for use of tax return information under any circumstance. Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use, without your consent, your tax return information for purposes other than the preparation and filing of your tax return. You are not required to complete this form. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year.

PRIVACY STATEMENT

If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at complaints@tigta.treas.gov. PRIVACY STATEMENT Your privacy is very important to us at Economy Tax. We are providing this statement to inform you about the types of information we collect from you, and how we may disclose or use that information in connection with the services we provide. This Privacy Statement describes the privacy practices of our company as required by law. During the course of providing our services to you, we may offer you various other services that may be of interest to you based on our determination of your needs through analysis of your data. Your use of the services we offer constitutes consent to our disclosure of tax information to the service providers. If at any time you wish to limit your receipt of promotional offers based upon information you provide, you may call us at (318) 688-7278.

Your Signature*

More Information

Our goal is to provide you with financial education and assistance beyond your annual tax return.

Please check below if you would like more information on any of the following services (select all that apply):

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Paying off debt/Financial Independence

Life insurance (personal or key man coverage for business)

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