TAXPAYER QUESTIONNAIRE

TAXPAYER QUESTIONNAIRE
Primary Taxpayer Information
Who is preparing your taxes (Please type their name)*
Who referred you this season? If noone put N/A
What tax year are you filing (ie., 2020, 2021, 2022, 2023) If you are filing for the work you did in 2024 the tax year you are filing is 2024*
PERSONAL INFORMATION
Name*

First NameLast Name
M.I*
SSN*
Date Of Birth*

MonthDayYear
I have stateside military address
Address*

Street Address

Apt/Lot/Unit#

CityState

Zip Code
Email address:*
example@example.com
Home Phone*
Taxpayer or spouse served in a combat zone during the current tax year.
Combat Zone Special Processing *
Date of Deployment (if applicable)

MonthDayYear
Date
Taxpayer was affected by a natural disaster during the current tax year. If so, list the Disaster Designation
Do you or your dependents have an IP PIN#? If so please list the names and numbers below.

Spouse Information
Name

First NameLast Name
M.I
SSN
Date Of Birth

MonthDayYear
Home Phone
Work Phone
Cell Phone
Can you be a dependent on another return?

YesNoN/A
Legally Blind?

YesNoN/A
Disabled

YesNoN/A

Bank Information
Account Type:*

CheckingSavingUsing tax office prepaid cardWant to receive a check
Bank Name (complete if electing direct deposit)
Routing Number (complete if electing direct deposit)
Account Number (complete if electing direct deposit)
Will this refund go into an account outside of the United States?*

YesNoN/A
Taxpayer Signature*

Clear
Spouse Signature

Clear
Signature Date*

MonthDayYear
Date

DEPENDENTS INFORMATION
Number of Dependents
Dependent 1:
Name

First NameLast Name
Date of Birth

MonthDayYear
SSN
Relationship to Taxpayer
# of Months
Dependent 2:
Name

First NameLast Name
Date of Birth

MonthDayYear
SSN
Relationship to Taxpayer
# of Months
Dependent 3:
Name

First NameLast Name
Date of Birth

MonthDayYear
SSN
Relationship to Taxpayer
# of Months
Dependent 4:
Name

First NameLast Name
Date of Birth

MonthDayYear
SSN
Relationship to Taxpayer
# of Months
Dependent 5:
Name

First NameLast Name
Date of Birth

MonthDayYear
SSN
Relationship to Taxpayer
# of Months
Dependent 6:
Name

First NameLast Name
Date of Birth

MonthDayYear
SSN
Relationship to Taxpayer
# of Months

ATTESTATION AND DISCLAIMER
Tax Year You Are Filing For*
Taxpayer Name*
SSN:*
Spouse Name
SSN:

Type a question*

	Taxpayer Initial
DRH FINANCIAL SERVICES, is not responsible if taxpayer provides us with incorrect information (i.e. social security numbers for self, spouse, or dependents, last names, birth dates). This may delay your refund.
DRH FINANCIAL SERVICES, is not responsible for any IRS audits. All information obtained from the taxpayer and /or spouse must be presentable if the IRS audits your tax return
DRH FINANCIAL SERVICES, is not responsible for any incorrect tax figures provided by the taxpayer and/spouse. If your tax figures change you will need to do an Amendment. Prices vary
If you have any federal or government debts (i.e. school loans, child support. DPP, DFCS, etc ...) there is a chance that your refund will be applied towards your debt. You can call the offset department at 1-800-304-3107 or 1-800-829-7650 to see if your refund will be partially or fully taken. If your refund is fully taken your are responsible for paying the preparation fees
DRH FINANCIAL SERVICES, is not responsible for any discussions or changes the IRS or bank may make on disbursement dates, filing status or any other required information from the IRS.
DRH FINANCIAL SERVICES, is not responsible for any IRS glitch problems or IRS problems that may cause a delay in your tax refund. We DO NOT reimburse any bank fees in the event of this occurrence.
DRH FINANCIAL SERVICES, provides the taxpayer with ONE complimentary copy of their tax return. Should you need any additional copies, there is a $15 fee per copy (federal and state included).

Type a question

	Spouse Initial
DRH FINANCIAL SERVICES, is not responsible if taxpayer provides us with incorrect information (i.e. social security numbers for self, spouse, or dependents, last names, birth dates). This may delay your refund.
DRH FINANCIAL SERVICES, is not responsible for any IRS audits. All information obtained from the taxpayer and /or spouse must be presentable if the IRS audits your tax return
DRH FINANCIAL SERVICES, is not responsible for any incorrect tax figures provided by the taxpayer and/spouse. If your tax figures change you will need to do an Amendment. Prices vary
If you have any federal or government debts (i.e. school loans, child support. DPP, DFCS, etc ...) there is a chance that your refund will be applied towards your debt. You can call the offset department at 1-800-304-3107 or 1-800-829-7650 to see if your refund will be partially or fully taken. If your refund is fully taken your are responsible for paying the preparation fees
DRH FINANCIAL SERVICES, is not responsible for any discussions or changes the IRS or bank may make on disbursement dates, filing status or any other required information from the IRS.
DRH FINANCIAL SERVICES, is not responsible for any IRS glitch problems or IRS problems that may cause a delay in your tax refund. We DO NOT reimburse any bank fees in the event of this occurrence.
DRH FINANCIAL SERVICES, provides the taxpayer with ONE complimentary copy of their tax return. Should you need any additional copies, there is a $15 fee per copy (federal and state included).

The information contained in this office or on this website is of a general nature. It should not be construed as legal advice nor should it be acted upon in your specific situation without further details and/or professional assistance. Any use of information contaiend in this office or on our website is done so at the risk of the user, and the DRH FINANCIAL SERVICES, is not responsible for the result or outcome of its use.

DRH FINANCIAL SERVICES, does not guarantee, and is not liable for the truthfulness, accuracy, effectiveness or any resulting effects of the use of any information contained in this office or on the website. It is advised and it is the responsibility of the visitor of this office or website to seek proper instruction and/or seek professional assistance in all matters regarding taxes and the IRS.

DRH FINANCIAL SERVICES, is thus held harmless, released of, and users of information contained int this office or on this website assume full responsibility for , any violation of Tax laws and/or IRS procedure, and any other legal liability resulting from use of any information contained in this office or on this website.
Taxpayer Signature*

Clear
Spouse Signature

Clear
PRINTED NAME - CUSTOMER*
PRINTED NAME - Spouse
Signature Date*

MonthDayYear
Date

CONSENT TO DISCLOSURE OF TAX RETURN INFORMATION

For the purposes of this consent form, “we,” “us,” and “our” mean
(Who is preparing your tax return)*
Federal law requires this consent form be provided to you. Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution.

You are not required to complete this form to engage in our tax preparation services. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, 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 from the date of signature.

You have indicated that you are interested in receiving an Electronic Disbursement Service and/or Loan (or collectively, “Products or Services”) from Refund Advantage, a division of MetaBank, National Association. In order to provide you with the opportunity to apply for one of these Products or Services, we must disclose all of your "Specified Year of Filing" tax return information necessary for evaluating the request to Refund Advantage. If you request a more limited disclosure of tax return information, you will not be eligible to submit an application request for these Products or Services. If you would like us to disclose your "Specified Year of Filing" tax return information for this purpose, please sign and date your consent to the disclosure of your tax return information.

By signing below, you authorize us to disclose to Refund Advantage all of your "Specified Year of Filing" tax return information necessary for the evaluation and processing of your request for a Product or Service. You understand that if you are unwilling to authorize the disclosure and sharing of your tax return information with Refund Advantage, you will not be able to obtain a Product or Service, but you may still choose to have your tax return prepared and filed by us for a fee.
Printed Name of Taxpayer (Your Name)*
Tax Payer Signature (Your Signature)*

Clear
Printed Name of Joint Taxpayer (if applicable)
Joint Tax Payer Signature (if applicable)

Clear
Signature Date*

MonthDayYear
Date
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 e-mail at complaints@tigta.treas.gov.

CONSENT TO USE OF TAX RETURN INFORMATION

For the purposes of this consent form, “we,” “us,” and “our” mean
(Who is preparing your tax return)
Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use your tax return information for purposes other than the preparation and filing of your tax return without your consent.

You are not required to complete this form to engage in our tax return preparation services. If we obtain your signature on this form by conditioning our tax preparation 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 from the date of signature.

If you do not consent, you may still have your tax return prepared and electronically filed by us for a fee.

For your convenience, we have entered into an arrangement with third parties to provide qualifying taxpayers with the opportunity to apply for an Electronic Refund Disbursement Service and/or Loan product. To determine whether these products may be available to you, we will need to use your tax return information in order to calculate the amount of your anticipated refund.

If you would like us to use your tax return information to determine whether these products may be available to you while we are preparing your return, please sign and date this consent to the use of your tax return information.

By signing below, you authorize us to use the information you provide to us during the preparation of the specified tax return to determine whether to present you with the opportunity to apply for these products and services.
Printed Name of Taxpayer (Your Name)*
Tax Payer Signature (Your Signature)*

Clear
Printed Name of Joint Taxpayer (if applicable)
Joint Tax Payer Signature (if applicable)

Clear
Signature Date*

MonthDayYear
Date

Upload your DL or ID*

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Upload your dependent SS Cards

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Upload all W2, 1099, or any other income forms

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Upload any other forms that need to be filed

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TAXPAYER QUESTIONNAIRE

CONSENT TO DISCLOSURE OF TAX RETURN INFORMATION

CONSENT TO USE OF TAX RETURN INFORMATION