Second Look Business Tax Credit: INTAKE FORM

Second Look Business Tax Credit Form

**DEADLINE FOR THIS PROGRAM IS OCTOBER 15, 2024.**
Please be advised that before proceeding with this application process, it is important to understand that there are associated fees. The following fees are required to be paid in full upon submission of this application:
- OPTION 1: Pay in Full: The Client agrees to pay the initial fee of $900 for all three tax years upfront.
- OPTION 2: Partial Payment: The Client agrees to make an initial partial payment of $300 for One Year, with the REMAINING BALANCE due based on the number of years selected for tax preparation. For example:
  - One Year: The Client owes remaining $0 for one tax return.
  - Two Years: The Client owes remaining $300 for two tax returns.
  - Three Years: The Client owes remaining $600 for all three tax returns.
(*Additional Fees may apply. This initial payment is non-refundable and serves as a retainer for the tax preparation services.)
Please have the following available BEFORE proceeding with application:

1. Photo Identification (BOTH SELF AND ALL DEPENDENTS)

2. Social Security Card (BOTH SELF AND ALL DEPENDENTS)

3. Business EIN Letter

4. Personal Tax Return: 2021, 2022, 2023 (If applicable)

5. Business Tax Return: 2021, 2022, 2023 (If applicable)

6. Routing and Account Number

7. Create Username/Password at ID.ME

Personal Information:
Date

MonthDayYear
Date
Referral
Name

PrefixFirst NameLast Name
Phone Number
Social Security Number (SSN)
Personal Email
example@example.com
Select all that applies:

Born before January 2, 1959?Legally blind?Disabled?N/A

Business Information:
Business Name
Business Entity Type
Business Start Date

MonthDayYear
Date
Employer Identification Number (EIN)

Banking Information:
Account Type:

CheckingSavings
Bank Name
EX: Chase, Bank of America, Wells Fargo, etc.
Bankholder Name

First NameLast Name
Routing Number
PLEASE MAKE SURE INFORMATION IS CORRECT
Account Number
PLEASE MAKE SURE INFORMATION IS CORRECT
Account Number (2ND TIME FOR VERIFICATION)
PLEASE MAKE SURE INFORMATION IS CORRECT

Supplemental Information:
Identification (State ID only - Front)

PLEASE TAKE A PICTURE OF FRONT AND BACK OF ID.
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Identification (State ID only - Back)

PLEASE TAKE A PICTURE OF FRONT AND BACK OF ID.
Cancelof
Social Security Card

Cancelof
EIN Letter

Cancelof
Personal Tax Returns

IF APPLIABLE, PLEASE INCLUDE: 2021, 2022, AND 2023 PERSONAL TAX RETURNS.
Cancelof
Business Tax Returns

IF APPLIABLE, PLEASE INCLUDE: 2021, 2022, AND 2023 BUSINESS TAX RETURNS.
Cancelof
ID.ME
Dependent Information:
Identification for ALL DEPENDENTS (State ID Only)

PLEASE TAKE A PICTURE OF FRONT AND BACK OF ID.
Cancelof
Social Security Card for ALL DEPENDENTS

Cancelof

Payment Agreement:
This agreement ("Agreement") is made effective as of Date* , by and between TBD ("Service Provider") and {name} ("Client").
1. Services: The Service Provider agrees to deliver tax preparation services for the Client's tax return for: 2021 2022 2023 * .
2. Payment Terms - Initial Payment: The Client agrees to make an initial payment of $900 to begin the tax preparation process for the applicable tax years. This initial payment is non-refundable and serves as a retainer for the tax preparation services. I choose to following option: * .
  1. Pay in Full: The Client agrees to pay the initial fee of $900 for all three tax years upfront.
  2. Partial Payment: The Client agrees to make an initial partial payment of $300, with the remaining balance due based on the number of years selected for tax preparation. For example:
    
    One Year: The Client owes remaining $0 for one tax return.
    
    Two Years: The Client owes remaining $300 for two tax returns.
    
    Three Years: The Client owes remaining $600 for all three tax returns.
3. Additional Fees Conditional on Refund: The Client agrees that additional fees will only be applicable if they receive a refund from their tax filings for any of the tax years covered under this Agreement (2021, 2022, or 2023). Specifically:
  1. Refund-Based Fees: The Client agrees to pay the Service Provider an additional fee from any refund they receive for the tax years covered by this Agreement. This fee will be due upon receipt of the refund by the Client.
  2. Payment from Refund: Upon receiving a refund for the relevant tax year(s), the Client agrees to remit the applicable fee from the refund to the Service Provider. The Client acknowledges that the obligation to pay this fee is contingent upon the receipt of a refund and that no further payments are due if no refund is issued.
  3. Failure to Pay from Refund: If the Client fails to remit payment of the additional fees from the refund, the Service Provider reserves the right to pursue collection of the amount owed through legal or financial avenues.
4. Payment Terms - Conditional on Refund: The Client agrees to pay as follows:
  1. Automatic Deduction for 2023: The fee for the 2023 tax preparation services shall be automatically deducted upon completion of the 2023 tax return. The Client acknowledges and agrees to this automatic deduction of $3,000 from the refund or payment account.
    
    $1,500 for 2023 remaining for tax preparation services balanced owed.
  2. Payment for 2022 and 2021 Tax Returns: For the tax preparation services provided for the 2022 and 2021 tax years, the Client agrees to remit the sum of $4,500 per tax year, payable to the Service Provider. The Client is required to make payment for each year’s services as follows:
    
    $4,500 for 2022 tax preparation services balance owed.
    
    $4,500 for 2021 tax preparation services balance owed.
5. Automatic Payment Authorization:
  1. The Client further agrees that the fee for the 2023 tax return will be automatically deducted, as described above, from the Client's refund or account.
  2. Failure to remit payment for the 2022 or 2021 tax years does not absolve the Client from the automatic deduction for the 2023 tax services.
6. Amendment Permission:
  1. If the Client fails to pay the tax preparation fee in full within the specified timeframe, the Client authorizes the Service Provider to amend the tax return to include the unpaid balance of the tax preparation fee and services rendered.
  2. The Client will be responsible for paying the full amount of the return to the IRS if the return is amended.
  3. Payments for 2021 and 2022 must be made in full no later than 15 business days of retrieval of tax refund unless an alternative payment arrangement is agreed upon in writing.
7. Governing Law: This Agreement shall be governed by and interpreted in accordance with the laws of the State of California.
8. Entire Agreement: This Agreement represents the entire understanding between the parties regarding its subject matter and supersedes all previous agreements, whether written or oral.
I UNDERSTAND, AGREE, AND ACKNOWLEDGE THAT I HAVE READ THIS AGREEMENT TO IT'S ENTIRETY. I CERTIFY THAT I WILL COMPLY WITH ALL OF THE PROVISIONS OF THE AGREEMENT.

{name} Signature*

Payment Information:

Select an Option:

OPTION 1: PAY IN FULL$900 - Total Initial Filing Fee for 3 years tax returns. (*Additional Fees may apply. This initial payment is non-refundable and serves as a retainer for the tax preparation services.)

$900.00 Quantity

OPTION 2: PARTIAL PAYMENT$300 - Partial Initial Filing Fee for 1 year tax return, then pay remaining amount dependent upon year(s) of Tax Refund Received. Remaining payment is due no later than 15 business days after retrieval of Refund. (*Additional Fees may apply. This initial payment is non-refundable and serves as a retainer for the tax preparation services.)

$300.00 Quantity

Enter coupon

Total

$0.00

Should be Empty:

Second Look Business Tax Credit Form

Personal Information:

Business Information:

Filing Status:

Banking Information:

Supplemental Information:

Dependent Information:

Payment Agreement:

Payment Information: