Rapid Refund Specialists
Client Intake Form
Appointment Date
*
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Month
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Day
Year
Date
Personal Information
Filing Status
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Name
*
First Name
Last Name
SSN
Date of Birth
*
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Month
-
Day
Year
Date
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Drivers License Number and State
*
Drivers License Issuing Date
*
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Month
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Day
Year
Date
Drivers License Expiration Date
*
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Month
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Day
Year
Date
Did you receive unemployment?
Yes
No
Did you receive a refund in 2023?
Yes
No
Did you receive Social Security Income?
Yes
No
Are you a full-time student?
Yes
No
Are you disabled?
Yes
No
Can you be claimed as a dependant?
Yes
No
Spouse Information (If Applicable)
Name
First Name
Last Name
SSN
Date of Birth
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Month
-
Day
Year
Date
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Drivers License Number and State
Drivers License Issuing Date
*
-
Month
-
Day
Year
Date
Drivers License Expiration Date
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Month
-
Day
Year
Date
Are you a full-time student?
Yes
No
Dependant Information
Name
First Name
Last Name
SSN
Date of Birth
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Month
-
Day
Year
Date
Name
First Name
Last Name
SSN
Date of Birth
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Month
-
Day
Year
Date
Name
First Name
Last Name
SSN
Date of Birth
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Month
-
Day
Year
Date
Name
First Name
Last Name
SSN
Date of Birth
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Month
-
Day
Year
Date
Name
First Name
Last Name
SSN
Date of Birth
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Month
-
Day
Year
Date
Name
First Name
Last Name
SSN
Date of Birth
-
Month
-
Day
Year
Date
Are you a full-time student?
Yes
No
Are you disabled?
Yes
No
Can you be claimed as a dependant?
Yes
No
Tax Questions
Employment Status
Employed
Unemployed
Self-Employed
Do you own your home?
Yes
No
Did you take money from your 401k?
Yes
No
Do you have mortgage interest?
Yes
No
Did you receive federal tax last year?
Yes
No
Are you a victim of identity theft?
Yes
No
Documents
Please upload your document
*
Browse Files
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Choose a file
Drivers License
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Social Security Cards
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Birth Certificates
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Medical Cards
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W-2s
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Browse Files
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1099's
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Browse Files
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2023 Tax return (if applicable)
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Business Income Profit or Loss Statement
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Browse Files
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Utility Bill
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Browse Files
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Last PayStub
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Browse Files
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1095A
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Other Documents
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of
Banking Information
Would you like to apply for a refund advance? (Banking fee apply)
Yes
No
Name of Bank
Routing Number
Account Number
Doyou receive an IP Pin every year? If so place it here.
Acknowledgment & Signature
I have confirmed that all of the information I have entered is accurate and true.
I allow Rapid Refund Specialists to capture my sensitive data such as Government ID, Social Security Number, and other information.
I have read the terms and conditions and privacy policy of Rapid Refund Specialists.
By signing below, you acknoledge that you havereead and understand your responsibilities and our responsibilities in doing this tax return.
Signature
*
Date
*
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Month
-
Day
Year
Date
Submit
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