Client Information Form

Client Information Form
READ AND SIGN BEFORE PROCEEDING

Dear client:

We are looking forward to working with you this year and appreciate your business!

This letter confirms our agreement for Integrity Tax to prepare your federal and applicable state income tax returns based on the information you provide.

You are responsible for providing complete and accurate income, deduction, credit, and dependent information, along with supporting documentation. We do not audit or independently verify the information submitted. You are also responsible for reviewing your completed tax return before signing and authorizing filing.

We will comply with IRS due diligence requirements and may request additional documentation. Failure to provide requested information may delay or prevent filing.

Fees are based on the complexity of the return and are due prior to filing unless otherwise agreed. Fees are not contingent upon refund amounts.

Any refund advance or financial product is offered by a third-party lender and is subject to their terms and approval.

Our liability is limited to the fees paid for tax preparation services. We are not responsible for penalties, interest, or additional taxes resulting from incomplete or inaccurate information provided by you.

By signing below, you acknowledge that you have read, understand, and agree to these terms.
Signature for Engagement Letter*

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SingleHead of HouseholdMarried Filing SeparateMarried Filing JointlyQualifying Widower
Select your tax preparer*
Who referred you? Enter N/A if not applicable.*
YesNoN/A
LeaseUtility BillMortgage Statement

This section only needs to be completed if you are Married Filing Separately or Married Filing Jointly. Otherwise, you make skip to the next section.
Spouse Name

First NameLast Name
Spouse Date of Birth

MonthDayYear
Date
Spouse SSN
Spouse Occupation
YesNo

Dependent Information
If claiming dependents, please answer the questions below to confirm your eligibility under IRS guidelines.
What is your relationship to dependent(s)?*
YesNoN/A
YesNoN/A
If you are claiming a dependent who is not your biological child, please list why the parents are not claiming the dependents.*
YesNoN/A
YesNoN/A

Have you and your dependent(s) had health insurance in the last 12 months? If yes, who is the insurance provider?

Rows	Yes/No	Employer	Spouse Ins	Exchange/ Marketplace	Direct with Insurer	Medicare	Medicaid
Taxpayer
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

YesNo

Upload photo ID*

Cancelof
Upload Social Security Card

Cancelof
Upload Dependent(s) Social Security Card(s)

Cancelof
Upload W-2, 1099, and all other supporting documentation.

Cancelof
Upload 1098-T (college students)

You must upload 1098-T to receive education credit.
Cancelof
If filing HoH, please upload either utility bill, lease, or mortgage statement.

If not filing Head of Household, leave this field blank.
Cancelof
How would you like to receive your tax refund?
YesNo
Would you like to apply for a refund advance loan up to $7000?

Direct Deposit Information

Rows	Bank Name	Routing Number	Account Number
Enter Bank Data

We request that you upload a recent photo of yourself. This additional security measure is implemented to prevent tax and identity fraud. Your cooperation in ensuring the accuracy and authenticity of the information provided is appreciated.
Selfie Upload*

- I confirm that all information provided is true and accurate.
- I authorize Integrity Tax Firm to capture sensitive data such as my driver's license, social security number (SSN), taxpayer signature, and other information.
- By signing below you consent to Integrity Tax using the information provided to file your tax return and/or give a tax refund or tax liability estimate.
- If additional information is required, we will reach out to you promptly. We appreciate your cooperation and look forward to assisting you with your tax needs.
Date Signed

MonthDayYear
Date
Taxpayer Signature*

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