Tax Preparation Engagement & Payment Authorization

Tax Preparation Engagement & Payment Authorization

Complete this form to authorize iMpAcTz Solutions Group to provide tax preparation services and process payment. Your information is securely encrypted and confidential.
Client Information

Please provide your contact details.
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Scope of Services

Review the following information regarding the services to be provided.
iMpAcTz Solutions Group will prepare your federal and state income tax returns based on the information you provide. Our engagement does not include audit, review, or other assurance services. Please read the full scope of services in your engagement letter.
Client Responsibilities

Acknowledge your responsibilities as a client.
Please confirm you understand and accept the following responsibilities:
Due Diligence & Documentation

Please review and acknowledge the due diligence requirements.
You are required to provide all supporting documentation for your tax return, including income statements, deductions, and credits. Failure to provide adequate documentation may affect your filing.
I acknowledge that I have provided or will provide all necessary documentation for my tax return.
Bank Products

Information regarding available bank products.
Certain bank products may be offered to facilitate tax refund processing. Participation is optional and subject to eligibility.
I am interested in learning more about available bank products.
Fees & Refund Offsets

Review information about fees and potential refund offsets.
Fees for tax preparation services are due upon completion. Any refund offsets by tax authorities may affect the net refund amount. Please review your engagement letter for full details.
I acknowledge and accept the fee structure and understand that refund offsets may apply.
ACH Payment Authorization

Authorize payment for services via ACH.
By authorizing ACH payment, you agree to allow iMpAcTz Solutions Group to process payment for agreed-upon fees directly from your bank account. Your financial information is handled securely and confidentially.
Bank Name
Account Type
I authorize iMpAcTz Solutions Group to process payment via ACH for agreed-upon fees.
Upload Voided or Deposit Slips

Cancelof
No Chargeback Agreement

Acknowledge the no chargeback policy.
By signing below, you agree not to initiate chargebacks or payment reversals for authorized payments to iMpAcTz Solutions Group for services rendered.
I agree not to initiate chargebacks or payment reversals for authorized payments.
Electronic Communication Consent
Final Acknowledgment

Please review before signing.
By signing below, I confirm that I have read, understand, and agree to the terms and conditions outlined above and in the engagement letter.
E-Signature

Sign to authorize and complete this form.
Signature (use your mouse or finger to sign below)
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preparer Use Only (Hidden)

For office use only.
Preparer Name
PTIN
Office Location
Date Received

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Final Client Notice: Your information is protected under HIPAA and securely encrypted. Once submitted, this form cannot be edited. You will receive a copy of your signed engagement for your records.
Should be Empty:

Tax Preparation Engagement & Payment Authorization

Client Information

Scope of Services

Client Responsibilities

Due Diligence & Documentation

Bank Products

Fees & Refund Offsets

ACH Payment Authorization

No Chargeback Agreement

Final Acknowledgment

E-Signature

Preparer Use Only (Hidden)