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Intake Form

Do you owe any child support or IRS fees from previous years?*

Yes

Are you married?*

Yes

If yes, proceed to next question. If NO skip next set of questions.

Are you filing separate or together?

Separate

Together

First name*

Last name*

Email*

Phone*

Birthday*

Month

Day

Year

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Did you own or rent?*

Rent

Own

Upload Mortgage interest 1098 (if applicable)

Social Security Number*

Do you have Dependents ?*

Yes

If YES, proceed to next question. If NO skip next set of questions.

Dependent 1 First Name

Dependent 1 Last Name

Dependant 1

Dependent 1 Birthday

Dependent 1 Social Security #

Dependent 1 Gender

Male

Female

Dependent 2 First Name

Dependent 2 Last Name

Dependant 2

Dependent 2 Birthday

Dependent 2 Social Security #

Dependent 2 Gender

Male

Female

Dependent 3 First Name

Dependent 3 Last Name

Dependant 3

Dependent 3 Birthday

Dependent 3 Social Security #

Dependent 3 Gender

Male

Female

Do you have more than 3 Dependents ?*

Yes

2024 AGI #*

Identity Pin # (If Applicable)

Did you file last year?*

Yes

Did you file with me (THE PMR CODE) last year?*

Yes

Are you a new client with the PMR CODE?*

Yes

Do you have any W-2's?*

Yes

Are you self-employed?*

Yes

Business Name

Business Ein #

Upload Valid ID*

Upload ALL W-2s

Upload 1098-T College Tuition Form (If applicable)

Upload Unemployment 1099-G Form (If applicable)

Upload Social Security / Retirement SSA - 1099 (if applicable)

Upload Interest / Dividends / Stocks 1099-INT 1099-DIV 1099-B (if applicable)

Other Income Forms (Alimony received, gambling winnings, rent etc...)

Upload 1095-A Marketplace Insurance REQUIRED

Referral Name*

If new client please type the name of who referred you. If not, just type "N/A"

Bank Information*

Routing Number*

Account Number*

Bank Account Type*

Checking

Savings

Cardholder Full Name*

Card 16 Digit Number*

Card Exp Date*

Card CVV 3digit Code*

Billing Address*

Yes, subscribe me to the PMR Code SMS list to receive reminders, deadlines, and exclusive updates.

Signature*

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

THE PMR CODE

IG: @xnina_beana

Ninaquesada1997@gmail.com

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Enter Your Phone Number*

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