2025 Integrity First Client Intake Form

2025 Tax Client Intake Form
What tax year is this submission for? (Please ensure that only documents for the selected tax year are attached. If you need multiple years filed, each year must be submitted as a separate request with its corresponding documents.) *

2025 (Current filing year)20242023202220212020
Name

First NameMiddle NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
How did you hear about us? (If someone referred your please mention their name here)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County
Birthdate:

MonthDayYear
Date
Social Security Number:
Please select the filing status that you believe applies to your situation:

SingleHead of householdMarried Filing SeperateMarried Filing JointWidowed
Please upload your Drivers License/ID for you and your spouse (if applicable)

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Social Security Cards for each Individual you plan to list on your Tax Return*

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If you are filing head of Houshold, what documents will you provide for proof of head of household?

utility billrental leaserent receiptsmortgage interest paymentsProperty tax paymentsOther
Please upload proof of head of household, if applicable.

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Are you disabled?

YESNO
Are you diagnosed as disabled by a licensed Doctor?

YESNO
Please explain your disability in detail here:
Do you have a spouse?

YESNO
Spouse Full Name:

First NameLast Name
Spouse Email:
example@example.com
Spouse Phone Number:
Please enter a valid phone number.
Spouse Occupation:
Are you claiming dependents on this tax return?

YESNO
Dependent 1 Name, Dependent 1 Social Security #, Dependent 1 Date of Birth, Dependent 1 Relationship:
Dependent 2 Name, Dependent 2 Social Security #, Dependent 2 Date of Birth, Dependent 2 Relationship:
Dependent 3 Name, Dependent 3 Social Security #, Dependent 3 Date of Birth, Dependent 3 Relationship:
Dependent 4 Name, Dependent 4 Social Security #, Dependent 4 Date of Birth, Dependent 4 Relationship:
Please upload proof of residency for each dependent:

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Are any of your dependent(s) disabled?

YESNO
Are your disabled dependent(s) diagnosed as disabled by a licensed Doctor?

YESNO
If any of your dependent(s) are disabled list them here and list their disability:
If applicable, please explain why you are claiming a dependent who is not related to you. What are the circumstances under which you supported this dependent for at least six months of 2025? Please outline the support you provided to this dependent.
Are all the dependents you are claiming related to you by birth or bloodline? If not, please specify which child is not related to you.
Please answer if applicable: If your last name is different from your dependents' last names that you are filing, what is the reason for the difference? Please provide an explanation for why your last name and your dependents' last names are not the same.
Please answer only if applicable: If your income is at or below $13,000.00 and you have two or more children, how are you able to maintain your household? For example, did you receive government assistance such as Section 8, public housing, SNAP benefits, or other support?
If you are the father of the child and claiming the child. Please indicate the reason why the child is living with you and not the mother. Please outline the support you have provided to the child.
Did you receive 1095A marketplace health insurance??

YesNo
Upload 1095 A form here if applicable:
Upload 1095 A form here if applicable:

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Do you or your dependents have an IP PIN#?

YesNo
List IPPIN# here if applicable and WHO it was issued to:
Were you audited by the IRS last year?

YesNo
Do you have any credits that were disallowed or reduced?

YesNo
If you have any credits that were disallowed or reduced, please enter here.
If you own your home, have you received form 1098 from your mortgage lender?

YESNO
Please upload 1098 Mortgage Interest form if applicable:

Cancelof
Please answers only if it applies to you.
If your address is different than the one thats on your government ID or drivers license, please indicate the reason why
Federal Financial Documents
Please Select your Income type (Select Multiple if applicable)

W2 EmploymentSelf EmployedUnemployed (please select if you received unemployment at any point within the year)I receive Social SecurityOther
Occupation Title:
Financial Tax Documents (W2,1099,Unemployment,ect)

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If you received a 1099G form for unemployment, please upload it here.

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Did you or your dependent attend College?

YESNO
If you received a 1098T form for school, please upload here.

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Do you need assistance with organizing your/side hustle business income & expenses?

YesNo
Did you have a business in 2025? This includes any 1099 work or side businesses, such as hair braiding, hairstyling, babysitting, Uber, Lyft, DoorDash, etc. If so, what is the name and nature of your business or side hustle? If you don’t have a business name, you can skip that part.
Did you use your vehicle for business use?

YesNo
If yes, please list the year make and model of the vehicle.
Other Documents

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Do you want to apply for a cash advance of up to $7,500? No credit check is required. You will be notified of your approval within 24 hours, and funds will be deposited within 48 hours.

YesNo
How would you like to receive your refund?

Direct DepositPrinted CheckPrepaid Debit Card
If you selected direct deposit, please enter your information below
Bank Name:
Account Number:
Confirm Account Number:
Routing Number:
Confirm Routing Number:
Tax Form Abandonment/Ach Agreement

Here at Integrity First Tax and Financial Services. Unfulfilled Tax Quotes will result in a $150 Service Fee - If the client decides to file their tax return elsewhere. This fee will be processed through our payment merchant until fulfilled. If the client files their taxes with us, they will be charged the regular tax filing fees processed from the tax return per usual. No upfront fees - all fees will be cured from the tax return unless otherwise agreed due to intricate tax situations. Thank you - Integrity First Tax and Financial Services.
Integrity First Tax and Financial Services

Will prepare your 2025 individual tax return from the information you furnished to us. You, the taxpayer, are ultimately responsible for the preparation and filing of your tax return. I, the Taxpayer named above, have provided to Integrity First Tax and Financial Services, LLC the attached tax information and to the best of my knowledge this information is true, correct, and complete.
Security Question *
Security question answer:
CONSENT TO USE OF TAX RETURN

INFORMATION For the purposes of this consent form, “we,” “us,” and “our” mean

Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use your tax return information for purposes other than the preparation and filing of your tax return without your consent. You are not required to complete this form to engage in our tax return preparation services.

If we obtain your signature on this form by conditioning our tax preparation services on your consent, your consent will not be valid. 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. If you do not consent, you may still have your tax return prepared and electronically filed by us for a fee.

For your convenience, we have entered into an arrangement with third parties to provide qualifying taxpayers with the opportunity to apply for an Electronic Refund Disbursement Service and/or Loan product. To determine whether these products may be available to you, we will need to use your tax return information in order to calculate the amount of your anticipated refund. If you would like us to use your tax return information to determine whether these products may be available to you while we are preparing your return, please sign and date this consent to the use of your tax return information.

By signing below, you authorize us to use the information you provide to us during the preparation of your 2025 tax return to determine whether to present you with the opportunity to apply for these products and services.

If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by e-mail at complaints@tigta.treas.gov.
CONSENT TO DISCLOSURE OF TAX RETURN INFORMATION

For the purposes of this consent form, “we,” “us,” and “our” mean .

Federal law requires this consent form be provided to you. Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution.

You are not required to complete this form to engage in our tax preparation services. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, 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.

You have indicated that you are interested in receiving an Electronic Disbursement Service and/or Loan (or collectively, “Products or Services”) from Pathward, National Association. In order to provide you with the opportunity to apply for one of these Products or Services, we must disclose all of your 2025 tax return information necessary for evaluating the request to Pathward.

If you request a more limited disclosure of tax return information, you will not be eligible to submit an application request for these Products or Services. If you would like us to disclose your 2025 tax return information for this purpose, please sign and date your consent to the disclosure of your tax return information.

By signing below, you authorize us to disclose to Pathward all of your 2025 tax return information necessary for the evaluation and processing of your request for a Product or Service. You understand that if you are unwilling to authorize the disclosure and sharing of your tax return information with Pathward, you will not be able to obtain a Product or Service, but you may still choose to have your tax return prepared and filed by us for a fee.

If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by e-mail at complaints@tigta.treas.gov.
Letter of Engagement

Thank you for choosing Integrity First Tax and Financial Services to assist you with your income tax preparation needs. We are committed to providing accurate and reliable services, and to ensure clarity in our professional relationship, please review the following details.

Scope of Services
We will prepare your income tax returns based solely on the information you provide. Upon completing your tax returns, we will return any original documents to you. While our office may retain electronic copies of certain documents for record-keeping purposes, you are responsible for maintaining all original records, receipts, canceled checks, and other documentation that support your income, deductions, and tax positions.

These documents may include but are not limited to:

Records supporting deductions for meals, travel, business expenses, charitable contributions, and vehicle use (if applicable).
Bank and credit card statements or other financial records.
It is your responsibility to retain these documents for at least five years after the filing or due date of your tax returns, as they may be required in the event of an audit or review by tax authorities.

Limitations of Our Services
Our work in preparing your tax returns does not include the identification or detection of errors, irregularities, or illegal acts, including fraud. We will exercise professional judgment to resolve any tax law ambiguities in your favor where possible and reasonable. However, we cannot guarantee that the positions taken will not be challenged by taxing authorities, nor can we predict the outcome of such challenges.

Integrity First Tax and Financial Services cannot be held responsible for issues arising from incomplete or inaccurate information provided during the preparation process. It is critical that you disclose all income, expenses, and relevant details before filing.

Fees and Payment Terms
If you decide not to file your tax return after we have completed it, a fee of $150.00 will be charged for services rendered. This payment is due immediately.

In the event of nonpayment for services, Integrity First Tax and Financial Services reserves the right to pursue legal action to collect any outstanding balance. You may also be responsible for reimbursing our firm for legal or collection costs incurred.

Thank you again for entrusting Integrity First Tax and Financial Services with your tax preparation. We look forward to working with you and ensuring your financial success.
Tax Payer Signature ( Must be legible)

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Spouse Signature

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Notes:
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2025 Tax Client Intake Form

Upload 1095 A form here if applicable:

Please answers only if it applies to you.

Federal Financial Documents

If you selected direct deposit, please enter your information below

Tax Form Abandonment/Ach Agreement

Integrity First Tax and Financial Services