YOUR KAR COMPANY DOWN PAYMENT ASSISTANCE

Down Payment Assistance Client Intake Form

Thank you for completing your Client Questionnaire. For new clients, this information is essential to get started.
* Indicates required fields.
Referred by:
If you were referred to me by someone, please enter their name and number to ensure they receive their referral fee.
Have you filed a tax return for the 2024 tax year already?*

YesNo
Name*

Example: Jr, IV, III ...etc.
CURRENT Address*

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth*

MonthDayYear
Date
SSN*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Occupation
Filing Status*

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower
Head of Household Document

Please upload an utility bill, lease agreement, or other household documents to prove expenses.
Cancelof
Please upload the front of your ID/DL*

Please take a clear picture of it on a dark background. Please do not hold the ID, just place it flat on a table or book.
Cancelof
Does any of the following apply to you?*

Full time studentBlindCan be claimed as a dependentPermanently disabledNone of these options apply to me
Were you previously issued an Identity Protection PIN (IP PIN) by the IRS?*

YesNo
IP PIN
6 numbers

Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
SSN
Please upload the front of your ID/DL

Please take a clear picture of it on a dark background. Please do not hold the ID, just place it flat on a table or book.
Cancelof
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
Does any of the following apply?

Full time studentBlindCan be claimed as a dependentPermanently disabled
Were you previously issued an Identity Protection PIN (IP PIN) by the IRS?

YesNo
IP PIN
Usually only 6 digits

Dependent # 1 Name*

FirstLastSuffix (Jr.,III, IV..etc)
Date of Birth*

MonthDayYear
Birthday
SSN*
SSN#
Relationship to You*
Ex: Son, Daughter, Parent, Grandparent…
Dependent # 2 Name

First NameLast NameSuffix
Date of Birth

MonthDayYear
SSN
Relationship to You
Ex: Son, Daughter, Parent, Grandparent…
Dependent # 3 Name

First NameLast NameSuffix
Date of Birth

MonthDayYear
Date
SSN
Relationship to You
Ex: Son, Daughter, Parent, Grandparent…
Do you have more than three dependents?*

YesNo
Please enter the dependents Name/SSN/Date of Birth & Your Relationship to the Dependent:
Please upload a copy of the dependent(s) birth certificate(s) and social security card(s) OR other document that has SSN on it.

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Do you have any expenses for child care?

YesNo
Do any of your dependents have tuition expenses?

YesNo

Did you purchase insurance from OR have any premium credits from the insurance company you use?

YesNo
If you have Insurance through your job (1095B) or Insurance through your state (Medicaid) (1095C) You do NOT need to upload them. We only require you to upload the 1095A form.
Upload 1095A

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Business Name (if different from your name)
Business EIN (if applicable)
If you do not have an EIN #, enter your SSN.
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Total Expenses
Select all that apply to you:

I used an automobile for this businessI used part of my home as an office and/or to do businessI had separate office space for this businessI hired employees or paid contractors over $600

Rows	Amount
Advertising
Repair & Maintenance
Auto Expense
Supplies
Commissions
Taxes & Licenses
Contractor Labor
Travel Mileage
Depletion
Meals
Interest Mortgage
Utilities
Legal & Professional
Office Expenses
Rent or Lease

Would you like to apply for the tax advance loan of up to $9,500? (The amount you are approved for depends on the amount of your refund).

Regardless of the method you select to receive your tax refund advance, your refund will be processed the same way. Please note, this choice cannot be changed, even if your advance is not approved.

Approval rate is about 79% and the bank will look at your refund history from previous year to determine approval. 4 out of 5 of my clients are usually approved.

**DISCLAIMER: DESPITE ODDS, REFUND ADVANCES ARE NOT GUARANTEED

THE BANK CAN APPROVE YOU FOR THE AMOUNT REQUESTED, DENY YOU, OR APPROVE YOU FOR A LESSER AMOUNT**
Would you like to apply?
How would you like to receive your tax refund advance loan?
Acknowledgment

I understand that the refund advance is not guaranteed and that loans over $1,000 will have small interest fee.I do not agree, I opt out of refund advance

You agree to provide us all income and deductible 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.

You affirm that all expenses or other deduction amounts are accurate and that you have all required supporting written records.

You must be able to provide written records of all items included on your return if audited by either the IRS or state tax authority. We can provide guidance concerning what evidence is acceptable.
- I confirmed that all information I entered here is accurate and true.
- I allow Rocket Refund Tax Pros LLC to capture my sensitive data like personal ID, government ID, social security number (SSN), and other information.
- I have read the terms and conditions and privacy policy of Rocket Refund Tax Pros LLC.
Consent & Agreement

By submitting this application, I understand and consent to providing my personal information, including but not limited to my full name, date of birth Social Security number, and banking information. I acknowledge that this information is necessary for verification purposes, to allow my tax professional to prepare my tax return. My tax professional agrees to use my personal information for tax filing purposes ONLY. I confirm that all information provided is true, accurate, and up to date.
- By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return.
Date Signed*

MonthDayYear
Date
Taxpayer Signature*
Spouse Signature
Date Signed

MonthDayYear
Date
Should be Empty:

Down Payment Assistance Client Intake Form