2024-2025 CLIENT INTERVIEW SHEET Tax Expertz

2024-2025 Client Interview Sheet

Please fill in the required information
For assistance please call or text 407-821-8271

2520 N Ronald Reagan Blvd Ste 116 Longwood FL 32750 * Instagram/ Facebook @Thetaxexpertz email: client.taxexpertz@gmail.com
Referred by*
Full name (& phone number)
Did the Tax Expertz prepare your prior year return?
If so which Tax Expert?
Are you applying for a Cash Advance*

YES minimum amountYes maximum amountNO
Are you interested in starting your credit repair journey with no money down today?*

YesNo
Do you currently owe or have a past due obligation with*

Child supportStudent loansIRSState or federal agencyI have no past due or over due obligation
Please select your filing status*

SINGLEHEAD OF HOUSEHOLD (must have active lease or utility bill)MARRIED FILING JOINTLYMARRIED FILING SEPERATE
Do you and your spouse have a Social Security Number that allows you to work? (ITIN)

NOYESSpouse NOSpouse YES

W2 OR 1099 FORM UPLOAD
File upload W2 or 1099 form

Cancelof

TAXPAYER
Taxpayer Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SSN#*
SSN CARD*

Cancelof
D.O.B.*
Cell phone*
Home phone
Work phone
File Upload picture of IPIN

Cancelof
IP PIN (identity protection pin)
Email address*
example@example.com
Occupation*

TAXPAYER SPOUSE
Taxpayer Spouse Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
SSN#
SSN CARD

Cancelof
D.O.B
Cell phone
Home phone
Work phone
File Upload picture of IPIN

Cancelof
IP PIN (identity protection pin)
Email address
example@example.com
Occupation

CHILDCARE PROVIDER INFORMATION
Provider Name
Phone Number
Please enter a valid phone number.
EIN/SSN
Total amount paid for the year
Address

Address

Street Address Line 2

CityState

Zip Code
File Upload Childcare provider letter (Proof of payments for 2024")

Cancelof

TAXPAYER IDENTIFICATION
Taxpayer Driver's License Number or State ID*
ISSUE DATE MM-DD-YY
Exp date MM-DD-YY
Spouse Driver's License Number or State ID
ISSUE DATE MM-DD-YY
Exp date MM-DD-YY
File Upload Phot ID or Govt issued passport*

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The Tax Expertz consent to use
2024"-2025"Consent to use Tax Return Information

("We, us, and our") Printed name of tax preparer)

Federal law requires this consent form be provided to you ("you" refers to each taxpayer, if more than one Unless authorized by law, we cannot use, without your consent, your tax information for purpose other than preparation and filing of your tax return.

You are not required to complete this form. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. Your consent is valid for time that you specify. If you do not specify the duration of your consent, your consent is valid for one year. If you do not consent, then you may still have your tax return prepared and electronically filed by us for a fee.

For your convenience, we have entered into arrangements with a bank to provide qualifying taxpayers with the opportunity to apply for a Refund Anticipation Loan (RAL), or Electronic Refund Check or Electronic Refund Deposit. To determine whether these products may be available to you, we will need to use your tax return information by analyzing it and calculating the amount of your anticipated refund.

If you would like us to use your tax return information to determine whether these products may be available to you while we are preparing your return, please sign and date this consent to the use of your tax return

By signing below, you (including each of you if there is more than one taxpayer) authorize us to use the information you provide to us during the preparation of your 2024 tax return to determine whether to present you with the opportunity to apply for these products and services.
Taxpayer (print)*
Taxpayer (signature)*

Clear
Date MM/DD/YY
Spouse (print)
Spouse Signature

Clear
Date MM/DD/YY

Disclosure
I understand by submitting my documents that The Tax Expertz will calculate my refund or re-payment amount based on the documents that I (Taxpayer/Taxpayer spouse) have provided, If for any reason more documents are needed I may need an amended return which will result in an additional fee. I accept full responsibility of what I have submitted and release The Tax Expertz of any and all liability claims that may or may not arise from the lack of documentation on my behalf (print name(s) in the box below)*
Signature*

Clear
Date MM/DD/YY*
Signature

Clear
Date MM/DD/YY
Should be Empty:

2024-2025 Client Interview Sheet

For assistance please call or text 407-821-8271

DEPENDENT INFORMATION

SCHEDULE C Form