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Hi, I’m Phillina, owner of Rebuild Riches

Tax & Finance Service!

Rebuild Riches Tax Intake Form-2025

Please complete all sections.

Please complete this form accurately.
All information is confidential and used solely to prepare your tax return.
Upload all required documents to avoid delays. Incomplete forms delay processing!

Client Information

Full Name

Date Of Birth

Email Address

Phone Number

Photo ID

Social Security Number

Upload clear photos or PDFs of all tax documents.

Incomplete uploads may delay processing.

File upload 1. Photo ID (Required)

File Upload 2. Social Security Card (Required)

Clients upload SS card , if card is not available write ss# number and upload it here.

File Upload 3. W-2

W-2 Only

W-2 Only

Self-Employed/1099

1099 NEC /1099 MISC

Untitled checkboxes field

Name of Business

Unemployment 1099 G

Social Security SSA-1099

Retirement 1099 R

School 1098 T

Current Address

Did your address change from last year tax filing?

yes or no

yes or no

IF NO add previous address

Previous Address

Dependents Names, Date Of Birth, SS#

New Clients Only -

Last year 2024 Tax Document /Page 1

INCOME SOURCES (required)

Check off what income services fit your needs!

Untitled checkboxes field

Upload any other documents needed

Mortgage 1098

Market Place Health Insurance

Upload health insurance

Account Information

Bank Name

Route Number

Checking Account

Saving Account