L and L Financial Solutions: Client Intake

L and L Financial Solutions: Client Intake
RemoteIn PersonHome Vistit
Previous ClientClient ReferralGoogleFacebookInstagram
If referred, Please type the first and last name of who referred you.
Email
example@example.com
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
SSN
Example: xxx-xx-xxxx
Date of Birth

MonthDayYear
Date
Please upload your State Issued Picture ID.

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Please Upload Social Security Card

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Spouse's Email Address
example@example.com
Spouse's Full Name

First NameLast Name
Spouse's Phone Number
Please enter a valid phone number.
Spouse's Job Title
Spouse's SSN
Example xxx-xx-xxxx
Spouse's Date of Birth

MonthDayYear
Date
Please Upload SPOUSE'S State Issued Picture ID.

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Please Upload SPOUSE'S Social Security Card.

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YesNo
YesNoNot Applicable
Single (Not Married)Married living with SpouseMarried not living with SpouseWidowed with a Dependent
YesNo
YesNo
Number of dependents
Dependent No.1

First NameLast Name
Dependent No.1 Date of Birth

MonthDayYear
Date
Dependent No.1 SSN
Example xxx-xx-xxxx
What is Dependent No.1 relationship to you? (son, daughter, etc.)
How many months out of the year did Dependent No.1 live with you?
Please Upload Dependent No.1 Social Security Card

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Please Upload Dependent No.1 Birth Certificate

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Dependent No.2

First NameLast Name
Dependent No.2 Date of Birth

MonthDayYear
Date
Dependent No.2 SSN
Example xxx-xx-xxxx
What is Dependent No.2 relationship to you? (son, daughter, etc.)
How many months out of the year did Dependent No.2 live with you?
Please Upload Dependent No.2 Social Security Card

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Please Upload Dependent No.2 Birth Certificate

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Dependent No.3

First NameLast Name
Dependent No.3 Date of Birth

MonthDayYear
Date
Dependent No.3 SSN
Example xxx-xx-xxxx
What is Dependent No.3 relationship to you? (son,daughter, etc.)
How many months out of the year did Dependent No.3 live with you?
Please Upload Dependent No.3 Social Security Card

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Please Upload Dependent No.3 Birth Certificate

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Dependent No.4

First NameLast Name
Dependent No.4 Date of Birth

MonthDayYear
Date
Dependent No.4 SSN
Example xxx-xx-xxxx
What is Dependent No.4 relationship to you? (son, daughter, etc)
How many months out of the year did Dependent No.4 live with you?
Please Upload Dependent No.4 Social Security Card

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Please Upload Dependent No.4 Birth Certificate

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YesNo
Name of Provider/ Business or Individual
Provider's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Provider's Phone Number
Please enter a valid phone number.
Provider's Tax ID or SSN
Total Paid
Please Upload Daycare Providers form

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YesNo
YesNo
If yes, please upload Taxpayer's and/or Spouse documents

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YesNo
Please select your health insurance provider
YesNo
YesNo
Please select DEPENDENTS health care insurance provider
Please Upload Taxpayer and Dependent(s) Insurance Documents

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YesNo
YesNo
YesNo
If yes, Please upload 1098-T form here

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CheckDirect DepositPrepaid CardRefund Easy Advance ($500-$7000)
Name of Bank
Checking AccountSavings AccountOtheer
Bank Routing Number
Bank Account Number
YesNo
CLIENT NON PAYMENT/ OFFSET CLAUSE

Here at L and L Financial Solutions, we understand that situations arise. If your tax refund is offset by the IRS due to student loans, child support, or your check is mailed, you are still obligated to pay our company the fees associated with filing your tax return.

By signing this agreement you acknowledge that if payment is not made in full with in 30 days, legal actions will be sought to resolve payment.
Primary Taxpayer's Signature

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Credit RepairBusiness Structure and FormationBookkeeping501c3 Status Set up
I am giving L and L Financial Solutions permission to prepare all forms related to my tax return; to apply for a secure Easy Advance loan on my behalf; and sign all necessary forms and file my tax return electronically.

I take full responsibility for the accuracy of this form and understand that L and L Financial Solutions and/or associated affliliates hold no responsibility for any misrepresentation or false claims
Taxpayer's Signature

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Date

MonthDayYear
Date
Spouse's Signature (if no spouse ,leave blank)

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Date

MonthDayYear
Date
Questions/ Comments
Please Upload all W-2/ 1099 forms here

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Please Upload Proof(s) of Residency Here

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Please Upload All Additional Tax Documents here

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Please verify that you are human*
YesNo
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