2025 𝑬𝒂𝒔𝒚𝐓𝐚𝐱 𝐅𝐫𝐞𝐞 𝐐𝐮𝐨𝐭𝐞 𝐅𝐨𝐫𝐦

𝑬𝒂𝒔𝒚𝐓𝐚𝐱 𝐏𝐫𝐞𝐩𝐚𝐫𝐚𝐭𝐢𝐨𝐧 𝐂𝐥𝐢𝐞𝐧𝐭 𝐐𝐮𝐨𝐭𝐞 𝐅𝐨𝐫𝐦

We're here to assist you in maximizing your financial potential. By filling out this simple form, you're taking a crucial step toward receiving a personalized, no-obligation quote that aligns with the latest tax benefits.
Filing Status

SingleHead of HouseholdMarried Filing SeparateMarried Filing JointQualifying Widower

Taxpayer Information
Name*

First NameLast Name
Age*
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
SSN*
Are you a full-time student?

YesNo
Are you totally and permanently disabled?

YesNo
Are you legally blind?

YesNo
Is this individual dependent of other?

YesNo

Spouse Information
Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Occupation
SSN
Are you a full-time student?

YesNo
Are you totally and permanently disabled?

YesNo
Are you legally blind?

YesNo
Is this individual dependent of others?

YesNo

Dependents

Enter your dependents here

	Name	SSN	Date of Birth	Relationship
1
2
3
4
5
6

Does you, your spouse, and your dependents have health insurance within 12 months last year? If yes, who covers for it?

	Yes/No	Employer	Spouse Ins	Exchange/ Marketplace	Direct with Insurer	Medicare	Medicaid
Taxpayer
Spouse
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5

Expenses
Please fill-up the information within the current year only.

General Expenses

	Amount
Medical Expenses
Dental Expenses
Insurance Premiums paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Investment Interest
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Tax Preparation Fees
Investment Expenses

Total Expenses
Additional comments

Choose Your Finance Preparer
Select one of our preparers below:*

SKIP TO OPT OUT OF LOAN | Tax Loan Advance – Qualification is Not Guaranteed
What amount are you looking to receive?

$250 - $1,000$1,000 -$3,0003,000 - $7,000
Do you understand that you may not qualify or may not receive the full amount requested?

YesNo

Acknowledgment & Signature
TERMS AND CONDITIONS

Accurate Information: "I confirm that all information I have provided is accurate and true, including but not limited to personal identification, government ID, Social Security Number (SSN), and any other requested information."
Data Collection: "I authorize Easy Financial Services to capture and store my sensitive data, including personal identification, government-issued IDs, SSN, and other necessary information for the purpose of processing the loan and tax return."
Acknowledgement: "I have read and understood the terms and conditions outlined in this agreement, as well as the privacy policy of Easy Financial Services."

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Repayment Responsibility: You, the customer, acknowledge and agree that you are solely responsible for repaying the loan. Easy Financial Services is not responsible for any repayment of the loan on your behalf. The loan repayment is contingent upon the successful filing of your taxes and the receipt of your tax refund. If you file your taxes elsewhere or do not receive your refund due to debts owed to the federal or state government, you will remain responsible for repaying the loan.

Court Fees: You agree to cover any and all court fees associated with the loan, including any collection or legal fees that may arise during the course of the loan repayment.

Garnishment: You acknowledge that in the event of non-payment or default, Easy Financial Services reserves the right to pursue garnishment of wages or other legal actions to recover the loan amount, in accordance with applicable law.
CLIENT SIGNATURE (PRINT FULL NAME)
Date Signed

MonthDayYear
Date
SPOUSE SIGNATURE (PRINT FULL NAME)
Date Signed

MonthDayYear
Date
Should be Empty:

𝑬𝒂𝒔𝒚𝐓𝐚𝐱 𝐏𝐫𝐞𝐩𝐚𝐫𝐚𝐭𝐢𝐨𝐧 𝐂𝐥𝐢𝐞𝐧𝐭 𝐐𝐮𝐨𝐭𝐞 𝐅𝐨𝐫𝐦