Client Intake (2025)

Bank Information, Payment Methods and Refund Advanced Loan
If you are entitled to a refund, how would you like to receive it?*

Direct DepositVisa Card (for in-person clients only)Paper Check (Must come to our office in Augusta, Georgia for pickup.
If eligible, would you like to apply for a Refund Advance Loan of up to $7500? (Additional banking and interest fees are added for this service.)*

YesNo
We are offering credit repair services exclusively for our tax clients. We can help you clean up your credit while filing your taxes. Is this something you have been needing?*

YesNo
Name of your bank or financial institution*
If Direct Deposit, which type of account would you like your refund deposited into?*

CheckingSaving
Routing Number*
Account Number*
Bank Verification Information: What was the name of your High School?*

SELF-EMPLOYED, 1099's and INDEPENDENT CONTRACTORS

Please complete if you are either
What is your total GROSS INCOME, RECEIPTS AND SALES for 2025?*
You have given us your gross income for 2025, what sources did you use to calculate this figure? How did you come up with these numbers? BE VERY DETAILED*
I came up with these calculations by adding up all of my receipts from cash app, Apple Pay, Zelle, Venmo. I didn't keep my records together so I had to go back and get the calculations by estimating the number of customers I had per week and multiply it by 4 for the month and then multiply that by 12.........
EXPENSES (If no expenses in field input 0 in field)
Advertising (Flyers, Cards, T-shirts)*
Contract Labor (Contractors you paid)*
Commissions and Fees*
Employee Benefit Program*
Health Insurance*
Insurance (other than Health)*
Long-Term Care Insurance*
Mortgage Interest(not your home)*
Other Interest(Business related loans)*
Legal and Professional Fees*
Office Expenses(Software, Postage,Booking Systems, Tax prep Fees)*
Pension and Profit Sharing*
Rent or Lease of Property (Rent/Booth Rent/Office Rent)*
Rent or Lease of Equipment (Business Vehicle, Tractor Trailer, Machinery...)*
Repairs and Maintenance(Business) *
Supplies (Cellphone bill, Products...)*
Taxes or Licenses(Business License)*
Travel (UBER,Lyft, Flights, Car Rentals)*
Meals (Business-Related Dining Only)*
Utilities (Business Lights/Cable/Internet)*
E-SIGNATURE: By typing my name below, I am attesting that the personal and financial information provided within this document to Clear Cents Resolutions is accurate and true. I am also giving Clear Cents Resolutions permission to prepare my tax return using said information provided. I allow you to capture my sensitive data like personal ID, government ID, Social Security Number and other information. I have read the terms and conditions and privacy policy. I acknowledge that I have read and understood my responsibilities in dong this tax return.*

I understand and agree.I do not agree. (We cannot process your tax return.)
Please type your full name.*
What is the date you completed this form?*

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Date
Notes by Preparer
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Client Intake (2025)

FILING STATUS

PERSONAL INFORMATION

COLLEGE INFORMATION

Dependents and/or IP PIN(s)

Bank Information, Payment Methods and Refund Advanced Loan

SELF-EMPLOYED, 1099's and INDEPENDENT CONTRACTORS

EXPENSES (If no expenses in field input 0 in field)