EZ INTAKE FORM

Tax Year*
Name*

First NameLast Name
Spouse Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Social Security Number*
D.O.B*
Spouse Social Security Number
Spouse D.O.B.
Who Is Your Preparer?*
How did you hear about us?*
Please List The Name*
If it was not a specific person put N/a
Do you have dependents?*
If yes, please list name, birthday, social security number and relationship. (Put N/a if none.*
Failure to put all requested information could stall the intake process.
Did your dependent(s) live with you more than six months?*
If claiming a dependent with special needs, can you provide proof?*
Did you pay for child care?*
Do you pay more than 50% of household bills?*
Do you or anyone have an ippin?*
Can anyone claim you as a dependent on their taxes?*
Do you have a disallowance?*
Do you have a debt with the IRS?*
Did you attend school and receive a 1098T?*
Did you have marketplace insurance?*

INCOME
Did you receive a W2?*
Upload ALL W2s

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Did you receive a 1099 NEC/MISC/K?*
Upload ALL 1099(s)

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Did you receive any of your small business earnings through a third-party app like cashapp, venmo, etc?*
Did you receive any of your small business earnings through a third-party app like cashapp, venmo, etc?*
What is your Occupation?*
Do you have an EIN, if so please type it below and include the exact name the EIN is registered under?*
Are you self-employed, if so what is your business?*
Do you have proper documents to prove your business income ie. financial statements, bank statements, receipts, etc?*
Did you incur business expenses?*
Do you have proper documents to prove your expenses ie. financial statements, bank statements, receipts, etc?*
Do you certify all answers are true, honest and accurate to your knowledge?*
If requested by the IRS, can you provide documentation proving answered questions?*
This an agreement between listed client and EZ FINANCIAL SOLUTION. I agree to have my federal and state tax return prepared by EZ FINANCIAL SOLUTION. I agree that this contract will be in effect from the date signed and valid for the current year tax return. I acknowledge that I have physically submitted all information, Dependent information, Child Care Expenses, Itemized deductions or anything that will require me to prove as being true.

I agree to examine everything on my tax return for accuracy prior to submission to the IRS for approval. Should my return be rejected by the IRS, EZ FINANCIAL SOLUTION will inform me of the rejection and what is needed from me prior to re submission. Corrections will then be made and there will be no additional charges for re submission. Upon approval, I shall expect my return in the form of a check, direct deposit or debit card in about 21 days of acceptance. Should my return be held by the IRS for review of some sort, I am responsible for payingEZ FINANCIAL SOLUTION their fees. Should my return be released later, Refund Advantage will deduct fees as pre-planned.

I agree that should I be audited by the IRS, it is my responsibility to provide all necessary information to them and not the responsibility of EZ FINANCIAL SOLUTION. I understand that EZ FINANCIAL SOLUTION will not discuss my tax return with anyone except myself. I also must authorize EZ FINANCIAL SOLUTION to allow someone other than myself to pick up my tax refund check. This person must sign for the check and show a valid photo government issued ID, in order for that person to receive my refund check. I agree thatEZ FINANCIAL SOLUTION will deduct their fees from my refund or I will pay the fees upfront at the time of service unless other arrangements are made. I am aware that the bank has charges that will be deducted from my refund as well.

By signing this agreement, I am acknowledging that I have read, understand and agree with the terms of this agreement.
Signature*

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Spouse Signature

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INCOME