Client Intake Form

  • Client Intake Form

  • The information you provide is to ensure the accuracy and completion of your tax return. Be advised of the tax services we will provide, consent to use, consent to disclose and your responsibilities as a client.

    • Welcome! Get started here! 

    • General Engagement for Individual Tax Preparation

       

      Tax Return Preparation

      • We will prepare your form 1040, U.S Individual Income Tax Return, state, and local tax return based on information you provide.
      • This engagement does not include any audit or examination of your books or records. In the event your return is audited, you will be responsible for verifying the information reported.
      • The tax return preparation fee does not include bookeeping. Additional fees apply for these services.
      • Fees charged for tax return preparation do not include audit representation or preparing materials to respond to correspondence from taxing authorities although, we will provide guidance on correspondence.
      • Preparation fees cover limited assistance and consultation during the year. In the event you require additional assistance or services, you will be billed at discussed rate.  
      • The engagement between you the client and Assure Financial Solutions will terminate upon either successful completion of your tax return and or in the event that other services are needed in regards to the tax return.
      • The first printed copy of your tax return is free of charge. Requests for additional printed copies will be assessed a fee of $10.
      • We reserve the right to terminate Preparer/Client engagement at any time.

      Taxpayer Responsibilities

      • You agree to provide us all income and deductibile expense information. If you receive additional information after we begin working on your return, you will contact us immediately to ensure your completed tax returns contain all relevant information.If you fail to provide all income documents or necessary tax information before your return is electronically filed, you acknowledge that you will be responsible for any additional fees incurred to prepare and file an amended return. You further understand that Assure Financial Solutions is not responsible for any penalties, interest, or additional tax liabilities resulting from incomplete or omitted information provided by you.
      • You must review the return carefully before signing to make sure the information is correct.
      • Fees must be paid before your tax return is delivered and filed for you. If you terminate this engagement before completion of your tax return, all original documents submitted by you will be returned.
      • Please store your supporting documents and copies of your tax returns in a secure place for at least 3 years.

       

      Bank Product Authorization & Fee Responsibility Statement

       By choosing to use our optional banking products to pay your tax preparation fees upfront, you authorize Assure Financial Solutions to check the IRS Debt Hotline for any outstanding federal or state debts that may affect your refund.

       If your federal refund is delayed, reduced, or fully offset due to any government debt (including IRS, child support, student loans, or other federal/state obligations), you understand and agree that Assure Financial Solutions will still collect all tax preparation fees owed, and you remain fully responsible for payment of those fees.

      Consent to Use Tax Information

       I hereby authorize Assure Financial Solutions to use the tax return information I provide for the purpose of preparing my federal and state income tax returns, communicating with me regarding my tax filings, and offering products or services directly related to my tax preparation. This consent is valid for the current tax year unless revoked in writing.

       Consent to Disclose Tax Information

       I authorize Assure Financial Solutions to disclose my tax return information to third-party service providers, financial institutions, software partners, and agencies when necessary to prepare, file, or process my tax returns, bank products, or related tax services. Disclosures will be made only as permitted by federal law and solely for the purpose of completing my tax preparation and associated services. This consent remains in effect for the current tax year unless revoked in writing.

    • Can another taxpayer claim you or your spouse as a dependent on their tax return*
    • Do you or your spouse owe any debts such as: IRS, State Agency, Child Support, Student Loans, ETC?*
    • Taxpayer Information 
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    • Date of Birth*
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    • Spouse Date of Birth
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    • Format: (000) 000-0000.
    • Format: (000) 000-0000.
    • If married, did you and your spouse live together for the last six months of 2025?
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    • Are you or your spouse disabled?
    • Was anyone in the home referred to Marketplace Health Insurance or purchase insurance through healthcare.gov last year?*
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    • Dependents 
    • Do you have any dependents?*
    • Are any of your dependents married?*
    • New Legislation enacted in 2025 provides for a tax advantage savings benefit for eligible dependents. (Born between January 1, 2025- December 31, 2028) A Child may qualify to receive up to $1,250, which may be funded by the federal government and/or private donors. This does not affect your tax refund and you are not obligated to participate. Would you like to sign your child up for this investment account?
    • Did you receive Child Support last year?
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    • Income 
    • Check all that apply
    • Rows
    • Did you use a vehicle for business purposes? Check all that apply.

    • Car, year, make, model Total Business Miles Date vehicle was placed in service for business   Pick a Date   

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    • Itemized Deductions 
    • Did you receive any government assistance? Snap benefits, Housing assistance, TANF, etc?*
    • State of Michigan only. Will you and another adult in the home claim the rent or property tax credit?*
    • Did you own your home or pay a mortgage last year? If so, attach form 1098 and any paid city property tax statements.*
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    • Did you sell stock, receive proceeds from sports bets or receive any gambling winnings last year? (If so please upload 1099-B or W2-G)*
    • Check all that apply.
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    • Complete 
    • Would you like a cash advance? Bank interest and fees apply.
    • Would you like to add audit protection for an additional fee?
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    • Acknowledgement & Signature 

    • Signatures.

      • I/We acknowledge that I/we have voluntarily provided Assure Financial Solutions with sensitive personal information as required for tax preparation.
        I/we understand that this data will be handled with the utmost confidentiality. 
      • I/We understand that ommitting any information could result in an inaccurate return. As a result this could delay the processing of your return.
      • I/ We confirm all information entered to be true and accurate.

      By signing below, you acknowledge that you have read, understand and accept your obligations and responsibilities in preparing your tax return. For a joint return, both taxpayers must sign.

    • Date
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    • Should be Empty: