Divine and Dedicated Tax Solution Client Intake form

Client Intake form

please read and fill out this form. Make sure you sign it, so there isn't any delays.
Date*

MonthDayYear
Date
REFUND OFFSET- please take a moment before you begin the application to call the Refund Offset number at 1-800-304-3107, this will help understand if you owe any federal or state agencies.

For all returning clients, we are on a new form, if there isn't any changes to your information only fill out the Taxpayer Information Section(filing status, name, email, phone, and address) and sign, we will handle the rest for you.

New Clients of DDTS(Divine and Dedicated Tax Solution) please make sure to fill out the form entirely, please make sure to upload ALL required documents.(not uploading documents will delay your process.)

To all clients, you do understand that Divine and Dedicated Tax Solution will prepare your return on your behalf. You understand that when applying for Holiday Loans, and Advances you are responsible for extra bank fees that will apply. You also understand that if you owe a tax refund you are still responsible for paying for prep fees and any additional fees that is applicable to your tax return. If the fees are not paid an automatic withdrawal will be taken from the checking/saving account that we have on file with us.

It's very important to be protected from Identity Theft.We encourage all to protect themselves and dependent(s) if applicable by setting up an account with the IRS at www.irs.gov. You can create an account with the idme(follow the simple steps to creating this account.) It helps to keep a track with your information including any notices.

We look forward to working with you in the future.

How did you hear about Us?
Are you a New/Returning Client?*

NewReturning
Referral Name

Refund Advances
Would you like to apply for an Advance when the season begins? up to $9,000.00

yesno

Taxpayer Information
Filing Status*

SingleMarried Filing JointlyMarried Filing SeperatelyHead of HouseHoldQualifying Widow
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth
monthdayyear
Social Security Number*
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Government Issued ID?

yesnon/a
State ID/ Driver License Number

Employment Status
Employment Status

EmployedSelf-EmployedUnemployedRetired
Occupation

Spouse Information
Employment Status

EmployedSelf-EmployedUnemployedRetired
Occupation
Name

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Social Security Number
Government Issued ID

yesnon/a
Government Issued Number
Issuing Date
Expiration Date

Filing Your Previous Tax Return
Did you file a Tax Return last year?*

yesno

Identity Protection Pin
Do you/dependent use a IP Pin?(this is a 5-digit number that is generated by the IRS to protect you information.)

yesno
IP Pin Number
IP Pin Number (dependent if applicable)

Dependents
Do you have dependent(s)?*

yesnon/a
Can your dependents(s) be claimed by anyone else?*

yesno
Did you pay any daycare expense?

yesnon/a
Does your Employer provide Day Care Expense?

Post-Secondary School
Did you or your dependents received a 1098-T form from a post-secondary school?

yesno

Documents
Social Social Cards*

Cancelof
State Issued ID's*

Cancelof
Previous Tax Return(New Clients Only)

Cancelof
Health Information( Employer Coverage Not Reported as well.)

Cancelof
Birth Certificates (Dependents)

Cancelof
Medical/School Records(Dependents)

Cancelof
Day Care Information(if Applicable)

Cancelof
Post-Secondary School(if Applicable)

Cancelof
Mortgage Interest(If Applicable)

Cancelof
Rental Lease(If Applicable)

Cancelof
Misc. Doc(Ip Pin, IRS Notices, Transcripts,etc.)

Cancelof

Banking Information
Some banks participate in Early Funding for an additional fee is charged to the taxpayer. Would you like to participate?(optional)*

yesno
Bank Name*
Routing Number*
Account Number*
Account Number(repeat)*

Acknowledgement Section

Signature(s)
Signature*

Clear
Spouse(if Applicable)

Clear
Should be Empty: