Dede w/Independent Tax Services - HEAD OF HOUSEHOLD E-APPLICATION

HEAD OF HOUSEHOLD

Tax Client E-Application Interview
Date

MonthDayYear
Date
Tax Preparation Fee(s):

W2 income only (Federal & States) $550.00Self employed / Schedule C (only) $650.00W2 & Self Employment $750.00Business / LLC / 940, 941 $1000.00Past Year Return $475.00Amendment In-House $275.00Amendment Out-House $475.00
Client Status:

NEW CLIENTRETURNING CLIENT [ONLY PROVIDE NEW/UPDATED INFORMATION AS/IF NEEDED]
E-Assistance [Returning Clients Only] $50.00

YES - I am requesting that my tax preparation services, complete my E-Application using my prior years submitted information on my behalf. I have provided any and all UPDATED INFORMATION AS NEEDED.
Choose your TAX YEAR AND SERVICE*

MAIN CLIENT INFORMATION
Your Name*

First NameLast Name
Your Birthdate*

MonthDayYear
Date
Your Social Security Number*
000-00-0000
TAKE A SELFIE OF YOURSELF HOLDING YOUR VALID ID AND UPLOAD IT HERE. PLEASE MAKE SURE YOUR ID IS CLEAR AND VISIBLE.
TAKE A SELFIE PHOTO WITH YOU HOLDING YOUR VALID ID. MAKE SURE THE ID IS NOT BACKWARDS OR BLURRY BEFORE YOU SUBMIT YOUR E-APPLICATION*

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UPLOAD SELFIE WITH YOU HOLDING YOUR ID Cancelof
UPLOAD A COPY OF JUST YOUR VALID ID HERE*

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Returning Client:

SAME AS LAST YEARS
Your address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Phone Number*

Area CodePhone Number
Your Email*
example@example.com

INCOME INFORMATION
What income statements will you be submitting? You can select multiple statements if needed.*

W21099 MISC1099 NEC1099K1099 [other]EIC CREDIT(S)SELF-EMPLOYMENT/SIDE INCOME/SCHEDULE CSCHEDULE K1, 1065, 1120, 940Other
How many income statements will you be UPLOADING?*
Each individual income statement must be uploaded below. Number of UPLOADS must match the number listed in the box
Do you have ANY ADDITIONAL income that you earn OUTSIDE/ON THE SIDE of your Full time/Part time W2 employment [SELF EMPLOYMENT]

YES (Please complete the Self Employment Statement to include this income)NO (Please continue)
PLEASE UPLOAD CLEAR COPIES OF ALL W2(S) and 1099(S) INCOME STATEMENT(S) BELOW.
W2 or 1099 [K,MISC,NEC,G,R]

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Make sure this is a clear copy Cancelof
W2 or 1099 [K,MISC,NEC,G,R]

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Make sure this is a clear copy Cancelof
W2 or 1099 [K,MISC,NEC,G,R]

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Make sure this is a clear copy Cancelof
W2 or 1099 [K,MISC,NEC,G,R]

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Make sure this is a clear copy Cancelof
More than [4] income/other statements? Upload additional statements here.

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Make sure each copy is CLEAR AND READABLE BEFORE SUBMITTING YOUR E-APPLICATION Cancelof
SELF EMPLOYMENT INCOME

If you are filing Self-Employment Income, you are required to complete the entire Self-Employment Statement below and provide your signature for authorization
Self Employment Status

New Self EmploymentUse prior year Self Employment Information Statement
Do you have an EIN Number from the IRS?

YESNO
Enter Your EIN (if you have one)
00-0000000
Do you have a name for your business/service?

YESNO
Brief Description of your business/services
Do you operate your business/service more than 6 months out of the year?

YESNO
Is this income your primary income that you use to support yourself?

YESNO
Is this your only source of income?

YESNO
Do you operate your business/service at your home address?

YESNO
How are you paid?

CASHACCRUALDIRECT DEPOSITSERVICES FOR WAGES

Please enter all income earned, expenses paid out and your final pay in the months you worked. If you did not earn income, enter 0 in the space provided.

	Income Earned	Expenses Paid Out	Pay Received
January
February
February
March
April
May
June
July
August
September
October
November/December

Self Employment Calculator. Use this calculator to add up all of your income received for the whole year. Then deduct all expenses needed to run your business/services. Enter those amounts below and provide a FINAL TOTAL.
Incomed Earned
Expenses Paid Out
Final Pay Received
Do you have any receipts to verify your INCOME EARNED and EXPENSES PAID OUT? For example: bank statements or invoices for income earned? Rent receipts, utility payment receipts, bank statement, paper receipts from cash transactions or personal ledger?

YESNO
Take a picture of each receipt
Take a picture of each receipt
Take a picture of each receipt
Upload a bank statement here

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Please provide any additional information about your self employment that would assist reporting your IRS/State file accurately.
Please provide your signature for verification and authorization

Clear

TAX REFUND DEPOSIT INFORMATION
How would you like to receive your tax refund(S)?

Direct DepositTax Refund Deposit CardPaper Check
BANK NAME*
NAME ON BANK ACCOUNT*
Name must match taxpayers name listed on the E-Application
CHECKING OR SAVINGS?*

CHECKINGSAVINGS401K CONTRIBUTION
ROUTING NUMBER*
000000000 [must be 9 digits]
ACCOUNT NUMBER*
Double check your account number before submitting your E-Application
UPLOAD ACCOUNT VERIFICATION HERE*

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REQUIRED TO UPLOAD Cancelof

SUPPORT THROUGH REFERRALS
Thank you for your business. Please help me grow my clientelle by referring 3-5 people you know for tax preparation services! You can earn $75.00 per client as soon as thier filing fees are paid in full.

Please enter thier names and email address below. We will email them an E-Application Invite to file thier taxes today!
Referral Name 1

First NameLast Name
Referral Email 1
example@example.com
Referral Name 2

First NameLast Name
Referral Email 2
example@example.com
Referral Name 3

First NameLast Name
Referral Email 3
example@example.com

PAYMENT & INSTRUCTIONS
How would you like to pay your Tax Preparation, E-File, Other Services fee(s)?:*

UPFRONT - via invoice by a credit or debit card. [E-submission will happen AFTER PAYMENT HAS BEEN RECEIVED]PAY LATER - I agree to pay my fee(s) out of the proceeds of my Federal and/or State tax refunds. I understand that if my filing fee's are unable to be collected from the proceeds of my Federal and/or State tax refunds, I will remit payment via invoice. [$89.95-104.95 bank fee included]

SUBMISSION & INSTRUCTIONS
Please ensure that you have provided all of your neccassary and required documents needed to prepare an accurate tax file BEFORE YOU SUBMIT YOUR E-APPLICATION. If you do not have everything, you can save your E-Application and continue later if needed.
- Valid ID(s)
- All dependents addeded
- Correct Address, email, phone number, spelling of name, birthdate
- Birth Certificates
- Social Security Cards
- Income Statements
- Bank Account information
Applications submitted successfully will receive an E-Application Submission Confirmation E-mail with POST FILING INFORMATION.

IF YOU DO NOT RECEIVE THIS EMAIL IMMEDIATELY AFTER YOU SUBMIT YOUR E-APPLICATION, THAT MEANS YOUR E-APPLICATION WAS NOT RECIEVED AND YOU WILL NEED TO RESUBMIT IT.

Make sure to save a copy for your records!

Thank you for your business and support!
Should be Empty:

HEAD OF HOUSEHOLD

TAKE A SELFIE OF YOURSELF HOLDING YOUR VALID ID AND UPLOAD IT HERE. PLEASE MAKE SURE YOUR ID IS CLEAR AND VISIBLE.

DEPENDENT # 1

Daycare Provider Information

SELF EMPLOYMENT INCOME