2024 Tax Client Intake Form

Do you have Dependents?

YesNo

Enter Dependent Information

	Name	DOB	SSN	Relationship
Dependent 1
Dependent 2
Dependent 3
Dependent 4
Dependent 5
Dependent 6

Dependent Information
Did you pay for childcare this year?

YesNo

Personal Deductions

Please enter any/all personal expense deductions for this filing year. Tax Payer may be subject to provide proof.

Personal Expenses

	Amount
Health Insurance
Life Insurance
Dental Insurance
Vision Insurance
Bank Charges/Fees
Continuing Education
Child Care
Cash Donations
Doantions (Goodwill, etc)
Other

Homeowner Deductions

	Amount
Repairs
Renovations
Maintenance
Landscaping
Security/Alarm
Other

*Note any details for any specific deductions and/or additional deductions*

Do you have a business?
Select

YesNo
Business Deductions

Tell us about your business
Business Name

Name of BusinessBusiness Profession/Type (i.e. Barber, Consulting, Construction.)
Employer Identification Number (EIN)
An employer identification number (EIN) is a nine-digit number assigned by the IRS.
Gross Sales
Gross sales is the total amount of revenue a company generates from selling its products or services before any deductions.

Vehicle Information

Make and Model

Total Mileage

Total Business MileageExpiration Date

ID Type

Do you have another business?

YesNo
Business

Business NameBusiness Profession/Type (i.e. Barber, Consulting, Construction.)
Employer Identification Number (EIN)
An employer identification number (EIN) is a nine-digit number assigned by the IRS.
Gross Sales
Gross sales is the total amount of revenue a company generates from selling its products or services before any deductions.

Vehicle Information

Make and Model

Total Milage

Total Business MilageExpiration Date

ID Type

	Amount
Advertising
Books
Business Cards
Bank Charges
Continuing Education
Rent/Mortgage
Utilities
Bond Insurance
Business Insurance
Liability Insurance
License & Permits
Payroll Wages
Payroll Expenses
Subcontractors & Contract Labor
Merchant Fees
Office Expenses

	Amount
Internet/Cable Fees
Telephone/Cell
Supplies
Security/Alarm
Computer Software
Equipment Tools
Lease/Rent Equipment & Machinery
Subscription Services
Postage/Freight/Delivery/Shipping
Legal Fees
Tax Fees
Travel Expenses
Uniforms/Laundry
Company Parties
Client Gifts
Entertainment
Food/Beverage
Other

	Amount
Lease/Loan Payment
Repairs
Auto Insurance
Registration
Maintenance
Gas
Parking/Toll Fees
Gas
Other

	Amount
Advertising
Books
Business Cards
Bank Charges
Continuing Education
Rent/Mortgage
Utilities
Bond Insurance
Business Insurance
Liability Insurance
License & Permits
Payroll Wages
Payroll Expenses
Subcontractors & Contract Labor
Merchant Fees
Office Expenses

	Amount
Internet/Cable Fees
Telephone/Cell
Supplies
Security/Alarm
Computer Software
Equipment Tools
Lease/Rent Equipment & Machinery
Subscription Services
Postage/Freight/Delivery/Shipping
Legal Fees
Tax Fees
Travel Expenses
Uniforms/Laundry
Company Parties
Client Gifts
Entertainment
Food/Beverage
Other

	Amount
Lease/Loan Payment
Repairs
Auto Insurance
Registration
Maintenance
Gas
Parking/Toll Fees
Other

UPLOAD YOUR TAX DOCUMENTS

See examples of required documents below
Upload all applicable tax documents (W2s,1099,1098,Expense Reports, etc.):

Cancelof
Examples of required documents:
- ID (for taxpayer and spouse)
- Social Security Card (for all filers and dependents)
- Income Statement
- W-2
- 1099
- Deduction Information
- Mortgage Interest Statement
- Student Loan Interest Statement
- 1098-TFor primary and secondary property [excluding rental property], please provide legible copies of all documents that apply for interest paid.
- Home Mortgage Interest [Attach form(s) 1098]
- Home Equity Line of Credit [HELOC]
- Mortgage Insurance Premiums [PMI]
For primary and secondary property [excluding rental property], please provide legible copies of all documents that apply for interest paid.

Home Mortgage Interest [Attach form(s) 1098]
Home Equity Line of Credit [HELOC]
Mortgage Insurance Premiums [PMI]

AGREEMENT OF SERVICES
I agree to use Mello Tax Solutions for the purpose of Tax services. Mello Tax Solutions has the authority to use my SSN and personal information in conjunction with providing these services. Mello Tax Solutions will keep all personal information confidential.

I agree to disclose any information pertinent to the services provided to me. I understand that failure to disclose information that is relevant to the services being provided may result in a delay of the desired outcome, monetary payout, and/or termination of services without reimbursement.

I agree to pay Mello Tax Solutions. Payment will be full upfront, or as negotiated before services. Mello Solutions reserves the right to garnish any monetary payout against my fees owed. Even if taxes are garnished by the IRS, I still agree to pay Mello Tax Solutions the remaining balance owed.

Failure to pay fees associated with services will result in a delay in final services. Mello Tax Solutions also reserves the right to retain legal action on any accounts that are 30 days past due. Mello Solutions reserves the right to refuse services to anyone at any given time.
Printed Name of Taxpayer*
First and Last
Date*

MonthDayYear
Date
Taxpayer Signature*

Clear
Printed Name of Spouse
First and Last
Spouse Signature

Clear
Date

MonthDayYear
Date
If you believe your tax return information has been disclosed, or utilized improperly in a manner unauthorized by law without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at Complaints@tigta.treas.gov.

CONSENT TO USE OF TAX INFORMATION
Tax Preparer: Mello Tax Solutions hereby referred to as “we”, “us” and “our”.
Federal law requires this consent form to be provided to you (“you” refers to each taxpayer if more than one). Unless authorized by law we cannot use your tax return information for purposes other than preparation and filing of your tax return without your consent.

You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on this form by conditioning our tax return preparation services, you agree that your information may be used for
the referral and sales of other services and products affiliated with and or provided by Mello Tax Solutions. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year from the date of signature.

For your convenience we have entered into an arrangement with Santa Barbara TPG (“SBTPG”) to provide qualifying taxpayers with the opportunity to apply for refund processing services offered by SBTPG. The calculated amount of your anticipated refund and analysis of your tax return information will determine whether these services may be available to you.

If you would like to use your tax return information to determine whether the services may be available to you while we are preparing your return please sign and date this consent form to use your tax return information.

By signing below you (“you” including each signatory, if there is more than one taxpayer) authorize us to use the information you provide to us during the preparation of your tax return to determine whether to present you with the opportunity apply for a refund processing service from SBTPG.
Printed Name of Taxpayer*
First and Last
Taxpayer Signature*

Clear
Date*

MonthDayYear
Date
Printed Name of Spouse
First and Last
Spouse Signature

Clear
Date

MonthDayYear
Date
If you believe your tax return information has been disclosed, or utilized improperly in a manner unauthorized by law without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at Complaints@tigta.treas.gov.

Non Disclosure Agreement

For Clients and affiliates of Mello Tax Solutions
This non-disclosure agreement is entered into on Date* between Mello Solutions (the principal), and First Name Last Name , Spouse First Name Spouse Last Name (the recipient referred to as the client).

Please leave blank for Spouse if not applicable.

The Principal acknowledges the Client(s) may receive information regarding the Owner’s business, practices, or other properties that may be considered confidential. Therefore, the Parties are in agreement to the following terms and conditions of this agreement.
Confidentiality For the duration of this non-disclosure agreement, any information the Client(s) may come into contact with that is not public knowledge and is made only available through contact with the Principal shall be deemed confidential.
This includes any information regarding intellectual property, clients, affiliates, business processes, marketing, design, vendors, pricing, technology, software, or products. The Client(s) should use common judgment when deciding if the information is confidential and, above all else, shall request approval from the Principal prior to the release of any questionable information.
Confidentiality Protection The Client(s) understands that the information deemed confidential is of value to the Principal and shall hold all information at the same level of confidentiality as personal information is held. The Client(s) agrees to hold all confidential information made available to standard non-disclosure terms and will not make said information available or disclose said information to third-party vendors or individuals without the Principal's prior written consent. The Client(s) shall under no circumstances modify or copy confidential information that is made available to them.
Unauthorized disclosure In the event any information is found to be disclosed by the Client(s) without prior written approval from the Principal, the Principal will be permitted to seek remedies including but not limited to legal assistance and termination of this agreement.
Non-Circumvention Upon entering into this non-disclosure agreement and for a period of 5 years after the conclusion or termination of this agreement the Recipient shall not partake in business with or solicit business that was made available from the Principal to the Client(s) for the purpose of circumvention. In the event such circumvention occurs the Principal shall be entitled to any and all compensation regarding any transactions that may take place from such events occurrence.
Return of Information Upon the conclusion or termination of this agreement the Client(s) agrees to return any information deemed confidential and in relation to this non-disclosure agreement. Any information that is unable to be returned must be destroyed immediately following the termination or conclusion of this non-disclosure agreement.
License to Use The Client(s) shall be permitted to use any and all information or products provided by the Principal strictly in the form such property is permitted. Furthermore, all property provided to the Client(s) shall remain the Principal's property and shall be treated as such.
License to Use The Client(s) shall be permitted to use any and all information or products provided by the Principal strictly in the form such property is permitted. Furthermore, all property provided to the Client(s) shall remain the Principal's property and shall be treated as such.
Entirety This non-disclosure agreement shall serve as the entire agreement between the Parties and shall prevail over any prior agreements conducted in written or oral form by the Parties.
Term The obligations of this non-disclosure agreement shall survive indefinitely including through termination or conclusion of this agreement.
Assignment The Parties agree to abstain from the sale, transferring, or delegating of any provisions of this agreement to third-party individuals without the prior written consent of the responding party. Any third-party individuals entered into this agreement shall be bound by all the terms and conditions contained within this agreement as so.
Jurisdiction This non-disclosure agreement shall fall under the jurisdiction of California, furthermore all legal proceedings occurring in relation to this agreement shall be conducted as such. The prevailing party in such proceedings shall have the opportunity to seek compensation for all court fees associated with said proceedings.
Notification Any and all notifications related to this non-disclosure agreement shall be produced in person, via courier, or via certified letter to the addresses listed below.
Agreement By affixing their electronic signatures below, the Client(s) acknowledge and agree to any and all provisions included in this non-disclosure agreement.

Mello Tax Solutions
Tax Preparation fees start at:

Personal or Business: $350

Bookkeeping Fee $300+

NOTE: The fees shown above are the starting prices for clients who make upfront payments only (i.e. ZELLE, CASH, CREDIT/DEBIT). If you choose Pay-by-Refund for tax preparation the above prices will increase and we will deduct our fees directly from your refund upon receipt.

OFFER in COMPROMISE (OIC)

$2500- Requires up front payment (ZELLE, CASH, CREDIT/DEBIT)

Beneficial Ownership Information (BOI) - $100- Requires upfront payment (ZELLE, CASH, CREDIT/DEBIT)
I acknowledge that I have read and fully understand the above information regarding fees.

Yes
Name*

First NameLast Name
Spouse Name

First NameLast Name
Signature*

Clear
Signature

Clear
Date*

MonthDayYear
Date
Date

MonthDayYear
Date
Do you want to pay for tax preparation directly from your refund (Pay-by-Refund)?

YesNo
Do you want direct deposit?

YesNo

Direct Deposit Authorization Signature

Clear
Referral Name
Thank You!

Your submission has been received.

We will contact you within 1-3 business days per your preferred method of contact, we look forward to speaking with you.

Mello Tax Solutions

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	Childcare Provider Name	Childcare Provider EIN or SSN	Childcare Provider Address	Childcare Amount Paid	Childcare Provider Phone Number
Childcare Provider 1
Childcare Provider 2

Client Intake Form

Spouse's Information

Dependent Information

Personal Deductions

Do you have a business?

Business Deductions

UPLOAD YOUR TAX DOCUMENTS

AGREEMENT OF SERVICES

CONSENT TO USE OF TAX INFORMATION

Non Disclosure Agreement

Thank You!