2025 TAX FILING CLIENT INTAKE FORM

2024 TAX FILING QUESTIONNAIRE

PLEASE FILL OUT ALL INFORMATION APPLICABLE
Never marriedMarriedDivorcedWidowed
Filing Status*
IndividualBusiness
Taxpayer's Name*

First NameLast NameSuffix
Social Security Number*
Upload your SOCIAL SECURITY CARD*

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Date of Birth*

MonthDayYear
NoYes
Upload a valid STATE PHOTO I.D.*

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Occupation*

Taxpayer can be claimed as a dependent on someone else's return.Taxpayer was over age 18 and a full-time student at an eligible educational institution.Taxpayer is blind.Taxpayer is deceased.Taxpayer wishes to contribute to the Presidential Election Campaign Fund.None of the above
Phone Number*
Please enter a valid phone numberFormat: (000) 000-0000.
Address*

Physical Street Address Only / NO PO BOX

Street Address Line 2

CityState

Zip Code
NoYes
E-mail*
example@example.com

Spouse Information

First NameLast NameSuffix
Spouse's Social Security Number
Upload SPOUSE'S SOCIAL SECURITY CARD & NON-EXPIRED DRIVER'S LICENSE/STATE ID

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Spouse's Date of Birth

MonthDayYear

DEPENDENTS*

Rows	First Name	Last Name	Suffix	Social Security Number	Date of Birth	Relationship	U.S Citizen
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Upload ALL DEPENDENT SOCIAL SECURITY CARD(S)*

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IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE FOLLOWING QUESTIONS AS IT PERTAINS TO YOUR RELATIONSHIP STATUS. PER THE IRS' REQUEST, WE MUST PROVE NOONE ELSE IS ELIGIBLE TO CLAIM THE LISTED INDIVIDUAL AS A DEPENDENT ALSO.
If claiming a son/daughter, where is the other parent of the dependent(s)?
YesNo
If claiming a niece/nephew, and/or an aunt/uncle where are the care takers of the dependent(s)?
If claiming a brother/sister why aren't the parents claiming them as dependent(s)?
YesNo

Refund Transfer Direct DepositRefund Transfer Debit CardRefund Transfer Paper Check

Banking Information*

Rows	Financial Institution	Routing Number	Account Number
Enter Banking Data

I, hereby, state that all information above is true to the best of my knowledge and that I am allowing The Filing Factory to prepare my taxes based on that fact. I understand that I am financially responsible for any outstanding balance due to any false information given. If there is a balace due, you must pay the tax preparation fee upfront. If for any reason you owe an entity and they take the entire refund, you are STILL responsible to pay the tax preparation fee for services rendered. *For any reason an admendment has to be filed with no fault of the tax preparer, and upfront fee of $150.00 is required. Please view your tax return, which is emailed to you (it is forwarded prior to submission). Any copy after the first copy is a fee of $10.00. ALL FEES (bank and service fees) are found in the return and are non-refundable nor negotiable! NO EXCEPTIONS!! Please utilize www.irs.gov for all federal refund tracking. Please utilize your state's Department of Revenue site for any state refund tracking. DO NOT add the amounts together. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have tracking questions. For any direct assistance, please email infofilingfactory@gmail.com.

IRS Contact - 1-800-829-1040

Click https://sa.www4.irs.gov/irfof/lang/en/irfofgetstatus.jsp to check your refund status.
Date*

MonthDayYear
Date
Signature*

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CONSENT TO DISCLOSE OR TO USE OF TAX RETURN INFORMATION

(Pursuant to Internal Revenue Code Section 7216)

For the purposes of this consent form, “we,” “us,” and “our” mean
ROCHELLE WALLACE___, named Tax Preparer.

Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more than one). 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 a Refund Advance Loan product from First Century Bank, N.A. To determine whether this Refund Advance Loan product 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 this Refund Advance Loan product 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 your 2024 tax return to determine whether to present you with the opportunity to apply for this Refund Advance Loan product.

Printed name of taxpayer:_{name}__________________

Printed name of joint taxpayer:_{name27}____________

Date:_{date92}______________

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 submitting a form on TIGTA’s website, www.tigta.gov.
Signature*

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2024 TAX FILING QUESTIONNAIRE