File Here

YEAR OF TAX PREP

NEW OR RETURNING CLIENT

Select Filing Status

FILING STATUS WILL BE ULTIMATELY DETERMINED BY INFORMATION GIVEN AND TAX PREPARERS DISCRETION

Name

First NameLast Name

Date of Birth

Date

Social Security Number

Occupation

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Are you a US citizen

Spouse's Full Name

First NameLast Name

Spouse's Date of Birth

Date

Social Security Number

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Occupation

Are you a US citizen?

Disabled

Number of Dependents

Name

First NameLast Name

Date Of Birth

Date

Social Security Number

Relationship

Is dependent US citizen?

Disabled

Name

First NameLast Name

Date Of Birth

Date

Social Security Number

Relationship

Is dependent US citizen?

Disabled

Name

First NameLast Name

Date Of Birth

Date

Social Security Number

Relationship

Is dependent US citizen?

Disabled

DOCUMENTS

DL/ID, SOCIAL SECURITY (SELF AND DEPENDENTS), BIRTH CERTIFICATE, LEASE (HEAD OF HOUSEHOLD) LIGHT BILL WILL BE FINE, ALL DEPENDENTS (MEDICAID, SCHOOL RECORDS OR SOMETHING WITH PROOF OF DEPENDENTS)

Did you, your spouse or any dependents attend college in 2024?

Did you receive health insurance through the Market Place?

Do you have a IP Pin?

If so, please enter it below

Would you like to see if you Pre-Qualify for a same day CASH ADVANCE up to $9,000? (ENDS 2/28/2025)

The loans offered is in amounts of 25%, 50% or 75% of your expected tax refund up to $9000. Some loans are an interest-bearing loan and will have an annual APR. It is a 36% APR

How would you like to recieve your refund?

Would you like your tax refund direct deposited into your bank account? If so, please complete bank information below:

Other

BANK NAME

ROUTING NUMBER

ACCOUNT NUMBER

Do you and your spouse understand and agree to the fees for Regency Millions Tax Services preparing your Federal/State Income tax return?

Choose your Tax Agent

I acknowledge that all information provided to Regency Millions Tax Services is true and accurate to the best of my knowledge. I understand that I am required to have any supporting documentation to validate the information provided. Furthermore, I understand that knowingly providing false information on my tax return and reporting it to the IRS, that I am taking part in a potentially criminal penalty situation and is punishable by law including but not limited to: facing court dates, restitution, and possible imprisonment. I waive Regency Millions Tax Services and the preparer of any error due to incorrect information provided by me. By signing below, I authorize Regency Millions Tax Services to file my tax return. I acknowledge by signing this form if I and/or my spouse owes a federal/government debt such as IRS,child support, student loans etc., I/we are still responsible for tax preparation fees due to Regency Millions Tax Services at the time of service. Also, if the federal refund amount is mailed, I/we are still responsible for the tax preparation fees stated on the invoice. If the tax preparations fees are not paid, I understand Regency Millions Tax Services will take legal action to collect the unpaid tax preparation fees.

Taxpayer Signature

Date

2025-26 TAX CLIENTS INTAKE FORM

FILING STATUS

TAXPAYER

SPOUSE INFORMATION

Dependents

FILING UPLOAD

BANKING INFORMATION