New Customer Intake Form
Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email Address
example@example.com
Did you file Taxes last year?
Yes
No
Do you have Valid Driver license and social security card/Birth Certificate for yourself and each dependent?
Yes
No
Will the customer be filing dependents?
Yes
No
Do you own a business?
Yes
No
Do you have any charitable donations for the year 2025 (Must have proof)
Yes
No
How much did you make for the year 2025?
Enter your total income for the year 2025 in USD
How Much Federal Tax Witthheld
Are You applying for the Refund Advantage Loan?
Please Select
YES
NO
PLEASE EXPLAIN
All Loans over $1000 a $100 processing fee and other fee's may apply.
How did you hear about us?
*
Please Select
Referral
In person
Social Media
Please Specify
*
Submit
Should be Empty: