New Customer Registration Form

Client Intake Form

Fast. Accurate. Maxium Refunds

All fields marked with * are required and must be filled

Personal Information:

# of Dependents Claiming:

Select Your Filing Status

Taxpayers Name:

First NameLast Name

Current Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Social Security Number:

Date of Birth:

Date

Occupation:

Email:

example@example.com

Phone Number

Format: (000) 000-0000.

Dependent Information: *

Dependent 1:

First and Last Name

Relationship:

Date of Birth:

Date

Social Security Number:

Dependent 2:

First and Last Name

Relationship:

Date of Birth:

Date

Social Security Number:

Dependent 3:

First and Last Name

Relationship:

Date of Birth:

Date

Social Security Number:

Dependent 4:

First and Last Name

Relationship:

Date of Birth:

Date

Social Security Number:

* If you are claiming a dependent, Please answer the questions below that pertains to your dependents realtionship. Per the IRS request, we must prove that nobody else is eligible to claim your dependent but yourself.

If claiming son/ daughter, where is the other parent of the dependent/dependents? Is the other parent providing any financial support?

If claiming niece, nephew, aunt, or uncle, how are you related to the dependent? Where are the parent’s to the dependent/ dependents?

If claiming brother or sister, How are you related to the dependent? Why are the parents not claiming the dependent/dependents?

If low income status, How are you able to provide for dependents?

Did you pay someone to watch your child or children?

Are you married?

Have you ever been married before?

Can you provide separation/divorce paperwork?

Did you collect social security or retirement income?

Did you purchase health insurance through healthcare.gov marketplace (Obama Care)?

If yes did you receive a 1095-A form from the marketplace?

Were you ever disallowed the E.I.T.C prior to this year?

Did you receive unemployment compensation (1099-G) regular or PUA last year?

If yes, did you receive regular unemployment or PUA?

Did you make college tuition payments and received a 1098-T Form last year?

Do you have any other income than your w-2(s)?

Do you have an IP Pin?

IP Pin

Do you owe any delinquent?

Please upload your most current unpaid balance statement by downloading it through your child support portal or contact your local child support customer service.

Please upload your most recent 2024 Tax Return or Tax Transcript.You can obtain this document by logging into your ID.me portal or by contacting IRS Customer Service for assistance. https://www.irs.gov/individuals/get-transcript?

Are you applying for the refund advance loan?

How would you like to receive your refund?

Bank information

I, hereby, state that all information above is true to the best of my knowledge and that i am allowing Golden Hart Finanical Services to prepare my taxes based on that fact. I understad that i am financially responsible for any outstanding balance due to any false information given.

If there is a balance due, you must pay the tax preperation fee upfront. If for any reason you owe an entity and they take the entire refund, you are STILL responsible to pay the tax preperation fee for services rendered.

*For any reason an amendment has to be filed with no fault of the tax preparer, an upfront fee of $150.00 is required! Please view you tax return, which is emailed to you (it is sent prior to submission). Any copy after that first copy is a fee of $10.00.

ALL FEE'S (bank and service fees) are found in the return and are non- refundable no negotiable! NO EXCEPTIONS TO THIS!!

Please utilize www.irs.gov for all federal refund tracking. Please utilize your state Department of Revenue site for any state refund tracking. Do NOT add the amounts together. Federal taxes are federal and state taxes are state when tracking your status. Please allow 8 weeks to surpass from the date of submission before calling the IRS, if you have any tracking questions.

For any direct assistance please email b.hart@goldenhartfinanical.com.

IRS contact 1-800-829-1040

Please click the link below to check your federal refund status. You will need your filing status , social security number, and the total amount before fees.

https://www.irs.gov/wheres-my-refund

Identification

Social Security Card

Head of Household

Dependent Birth Certificate

Dependent Social

W2

Self Employment

College Forms

Healthcare Forms

IP Pin (paper from the IRS)

Direct Deposit

Misc. Forms

Previous Year Tax Return (2024 Tax Return if Possible)

How did you hear about us?

Were you referred?

Who referred you? (First and Last name)

Appointment

Date

Signature

ADDITIONAL INFORMATION:

REFUND INFORMATION: