Upload-Securely File Your Taxes Online

WELCOME

This intake form serves as a follow-up to the survey and is designed to collect any additional information needed to complete your tax preparation. It will gather all necessary details to ensure accuracy and efficiency. You can expect a response within 24 hours after submission. Please read each question carefully and provide complete answers. Missing or incomplete information may lead to processing delays. Thank you for your prompt attention to this step!

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You are allowed to apply for either or both of the loans but keep in mind all tax information must be submitted. (Including W-2s if waiting, CAN NOT use pay stubs)

Do you want to apply for the NO fee advance up to $1000? (Available Jan 2nd-Mar 1st) *

Yes

Do you want to apply for a preseason loan for up to $9500? (loans available Jan 2nd-Mar 1st) *

Yes

Are you a new or returning client? *

New

Returning

Estimate

Social Security Number *

Social Security Card *

First Name *

Last Name *

Date of birth *

Unexpired Identification *

Occupation *

Phone *

Email *

Address

Street Address *

City

State

Country

Postal code

Spouse Full Name

Spouse Social Security Number

Spouse Date Of Birth

Spouse Number

Spouse Email

Spouse Occupation

Spouse Identification

Spouse Social Security Card

Dependent 1

Full Name
Social Security Number
Birthday
Relationship
Income (put 0 if n/a)
Yes/No for disabled
Yes/No Student

Dependent 1 Social Security Card

Dependent 1 Birth Certificate

Dependent 1- Insurance Form

Dependent 2

Full Name
Social Security Number
Birthday
Relationship
Income (put 0 if n/a)
Yes/No for disabled
Yes/No for Student

Dependent 2 Social Security Card

Dependent 2 Birth Certificate

Dependent 2- Insurance Form

Dependent 3

Full Name
Social Security Number
Birthday
Relationship
Income (put 0 of n/a)
Yes/No for Disabled
Yes/No for Student

Dependent 3 Social Security Card

Dependent 3 Birth Certificate

Dependent 3- Insurance Form

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Is any of the following true about the taxpayer?

Taxpayer can be claimed as a dependent on someone else's return. *

Yes

Taxpayer is blind. *

Yes

Taxpayer is deceased. *

Yes

Taxpayer was affected by a natural disaster during the current tax year. *

Yes

Taxpayer received, sold, or disposed of a digital asset (or financial interest in a digital asset) in the current tax year. *

Yes

Did you have insurance through the year? *

Yes

Insurance Form (1095-A/B/C)

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INCOME

W-2 (1)

W-2 (2)

W-2 (3)

W-2 (4)

W-2 (5)

W-2 (6)

1099-NEC (1)

1099-NEC (2)

1099-NEC (3)

1099-MISC (1)

1099-MISC (2)

1099-R

1099-SSA (1)

1099-SSA (2)

1099-G (Unemployment or Govt Payments)

W-2G (1)

W-2G (2)

W-2G (3)

Additional Income (Not Business)

___________

SELF-EMPLOYMENT

Business Name

Business Type

Year Business Established

Business Address

Address Line 1
Address Line 2
City
State
Zip

Gross Business Income

Expenses

Advertising
Car & Truck
Commission & Fees
Contract Labor
Home Office Expense
Depreciation
Insurance (Other than Health)
Interest
Legal & Professional Services
Office Expense
Rent or Lease of Property
Repairs & Maintenance
Supplies
Taxes & Licenses
Travel
Meals
Utilities
Entertainment
Wages
Business Miles (Log Needed)
Other Expenses
Other Expenses
Other Expenses
Other Expenses

___________

DEDUCTION QUALIFICATIONS

Did you and/or your dependent have qualifying college expenses and 1098-T? If so, upload below.

1098-T (1)

1098-T (2)

Did you pay qualify daycare or childcare expenses for a dependent 13 y/o or younger during 2023? Upload form below or if paying a person, list the amount paid, full name, address, and SSN of provider.

Dependent Care Form

Child Care Provider

Did you pay rent for your home/apartment?

Lease

Personal Landlord Information (Address where you mail payments)

Full Name or Company
Address Line 1
Address Line 2
City
State
Zip Code
Rent Amount
Months Rented

Did you pay property taxes?

Yes

ADDITIONAL INFORMATION

Referral

Any Additional Comments, Questions Or Special Requests?

I consent to Quick Stop Tax using my personal information for the SOLE purpose of preparing my (our) taxes. I understand I will be contacted within 24 hours or less if there is something missing. I still have to confirm my refund amount by email or phone to have it processed. *

Yes

Call 855-701-QTAX

-7829

Email: [email protected]

Site: www.quickstoptax.com

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