2026 Client Intake Form

Welcome 💕

I’m Sherell with Her Empire Co & I have partnered with Jace Tax Group this year !! Why you should file with me •Trustworthy •Patience •Fast turnaround •Guarantee to get you the Max back !
2026 Client Intake Form

If you have any questions about filling out this form or experience any issues while completing it, please text 205-810-1354 and I will assist you at my earliest availability. If you do not have a required document or a question does not apply to you, please answer “No” or skip that section. Thank you.
To properly complete this form for submission, please have the following documents readily available: a valid driver’s license, Social Security cards for yourself and any dependents you are claiming, W-2 forms or other documents supporting your income, any 1099 forms you may have received, and Form 1098-T if you are a student.
Referred By:
Or workplace you were referred from
Filing Status?
Your Full Name

First NameMiddle NameLast NameSuffix
Birthdate

MonthDayYear
Date
Social Security Number
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Gender
Occupation
Driver's License Number
State Driver's License was Issued
Driver's License Issue Date
Driver's License Expiration Date
Upload Photo of Driver's License

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Upload Photo of Social Security Card

If you do not have SSN Card, photo of temporary SSN from SSA is acceptable
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Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you eligible to be claimed as a dependent on another person's tax return?
Do you have healthcare through the Marketplace? (Affordable Healthcare Coverage/ www.healthcare.gov)?
Were you in school in 2025?
Did you invest in an IRA, annuity, or any other retirement plan outside of your job?
Do you own a business?
Type of Business
Business Name (skip if sole proprietor)
Business EIN (skip if sole proprietor)
Did you claim this business on your last year's return?
For business owners only
Upload W-2 Forms and Other Supporting Documents for Income

1099s 1098-T Any expense or income supporting documents Mortgage Interest Forms
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Qualifying Dependents
Do you have any eligible dependents you wish to claim on your Tax Return?

Enter Dependents

Rows	Name	Full SSN ###-##-####	Birthdate	Relationship
1
2
3
4
5
6
7
8

Did dependent(s) live in your care for 12 months?
Upload Dependent's Social Security Card or Supporting Documents

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Was there child care paid for the 2025 tax year?

General Expenses

Rows	Amount
Medical Expenses
Dental Expenses
Insurance Premiums Paid
Long Term Care Premiums
Prescription Drugs and Medications
Home Mortgage
Cash Contributions
Non-Cash Contributions
Unreimbursed Business Expenses
Union Dues
Investment Expenses

IT'S MY REFUND & I WANT IT NOW!
Do you want to apply for Cash Advance?
**Refund Advance Loans are subject to approval and we have no bearing on who is approved and who is denied. Advances range from $500-$7000 and are available January 2nd to March 15th. The amount of the loan and applicable interest will be deducted from tax refunds and reduce the amount that is paid directly to the taxpayer from the refund. Fees for other optional products or product features may apply and will be disclosed at the time of application. Refund Advance Loans will be issued by check or loaded on a Prepaid Visa, both of which can be picked up in the office or mailed via certified mail.**
Choose the method in which you would like to receive your refund
Did you receive a return last year?
How much did you receive in your prior year tax return?
If you have any student loans, do you know what status they are in?
Do you know of any OFFSETS (delinquent student loans, child support, tax liens, owe federal back tax, owe state tax, etc.) with the IRS that may prevent you from receiving your 2025 Tax Return?
If you are unsure, please consult with your tax preparer to complete this question. If you suspect that you have an offset, call (800)304-3107
FOR DIRECT DEPOSIT ONLY
Financial Institution Name
Bank Routing Number
Bank Account Number
Type of Account

Welcome 💕

2026 Client Intake Form

Qualifying Dependents

IT'S MY REFUND & I WANT IT NOW!