CONSENT TO DISCLOSURE OF TAX RETURN INFORMATION
For the purposes of this consent form, “we,” “us,” and “our” mean
_________________________
(Printed Name of Tax Preparer)
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 Pathward, 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 2023 tax return information necessary for evaluating the request to Pathward.
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 2023
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 Pathward all of your 2023 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 Pathward, 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.