Tax Filing Year

Select Your Tax Preparer

How did you hear about our business? Please provide the name of the person who referred you or where you found us.

Select Your Filing Status

If you are filing as Married Filing Separately, how many months during the year did you live apart from your spouse?

If you are filing head of household, are you unmarried?

Do you or your kids have an IP PIN?

Do you have marketplace insurance?

Did you get a refund last year? If so upload transcript or copy of tax return at the bottom of this form? (new clients ONLY)

Are you interested in credit repair?

Your Full Name

PrefixFirst NameLast Name

Your Phone Number

Area CodePhone Number

Your E-mail

example@gmail.com

Tax Payers Social Security Number

Tax Payers Date of Birth

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Did you receive health insurance through the Market Place?

Your Occupation

If yes, please provide the following information: 1. The states where you worked 2. The timeframe you worked in each state

Have you ever been audited by the IRS?

If so, Please provide the year/s of audit and what were the outcomes of the audits

Primary Taxpayer - Please Check Any That Apply

Spouse Information

If no spouse, please skip.

Spouse's Name

First NameLast Name

Spouse's Date of Birth

Date

Spouse's Social Security Number

Spouse's Occupation

Spouse's Email Address

example@example.com

Primary Taxpayer - Please Check Any That Apply

Dependent Information

The Earned Income Credit (EIC) increases with the first 3 Children you claim. The maximum number of dependents you can claim for Earned Income Purposes is Three. You MUST also meet other requirements related to your Adjusted Gross Income (AGI) to qualify for EIC. If you are MARRIED and FILING SEPARATE you CAN'T claim the credit.

Dependent Information

Rows	Name	Date of Birth	How old is the dependent?	Social Security Number	Full Time Student? Yes or No	Disabled? Yes or No?	How Many Months Did The Child Live In Your Home?	Relationship To The Dependent	If the dependent is 17 or older, is that dependent married?
Service Quality
Cleanliness
Responsiveness
Friendliness

Does your child/children have the same last name as you

If not, is it the last name of the child/children father?

TAXPAYER IP PIN (issued from IRS yearly) EVERYONE DOESNT HAVE THIS. IF IT DOESNT APPLY SKIP

Business Information

Please complete if you are self employed.

Are you self employed or a business owner?

If so what kind of business do you have?

Please provide your business EIN Number

Business Adress

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please upload your profit/expense records.

Did you have a vehicle you used for your business?

If so, list the year make and model of the vehicle.

Do you have a separate personal vehicle?

College Student Information

Please complete if anyone in your household went to college.

Did Anyone Listed On This Return Attend College this Tax Season

If so - please upload form 1098-T and other college related documents below.

Name(s) of the person who attended college

Did all students attend at least half time?

Were they seeking a degree?

How much money was spent on tuition or other required course materials?

How many tax years have you claimed the American Opportunity Tax Credit?

Was the student ever charged with drug related felonies?

Are You Currently Paying Student Loans?

How many tax years have you claimed the American Opportunity Tax Credit?

If so please upload your Form 1098-E - Student loan Interest

Upload Requested Documents

PLEASE NOTE: YOU CAN UPLOAD MULTIPLE DOCUMENTS

Upload ID/DL (for anyone over 18 years old on this filing)

(In order to file HOH upload lease and utility bill in your name) If filing single only a utility bill needed

Upload Social Security Card (for all listed on this filing)

Please upload all W2's HERE - You can upload multiple files

If you received Unemployment Please Provide 1099-G form

Withdrawal out of 401K? Please attach documentation if available.

Please provide Mortgage / Property Tax form(s) if paid taxes / insurance

Please Upload any Additional Tax Forms that you have Received.

Please upload Birth Certificates for all dependents.

Upload copy of prior year tax return or transcript (include the schedule c if was self employed)

Banking Information

Do you owe or have you owed the IRS?

Will you want any of the following Bank Products? (Choose All That Apply ) ** Please note all bank products must go through an approval process and will require a written authorization Form 7216 Bank Consent to Disclosure of Tax Return Information

If you want a tax loan advance:

Please Check This Box To Agree To All Of The Terms Of This Document

Requesting Bank Products that include but are not limited to:
Rapid Refunds, Withdrawing Tax Preparation fees from tax returns and other banking products require consumer consent of information disclosure.

Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more than one). Unless authorized by law, we cannot use, without your consent, your tax return information for purposes other than the preparation and filing of your tax return.

You are not required to complete this form. Our need to disclose your tax return information to another 3rd party affects the tax return representation services that we provide to you and its (their) cost.

If we may decline to provide you with the tax return preparation service or change the terms (including the cost) of the tax return preparation services that we provide to you.

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.

Signature Consenting to Form 7216 Bank Consent to Disclosure of Tax Return Information

How would you like your refund to be deposited when ready?

Bank Name

Is this a Checking or Savings account?

Routing Number

Confirm Routing Number

Account Number

Confirm Account Number

Due Diligence Questions

Have you ever been disallowed the Earned Income tax Credit, The additional child Tax credit, or the Child tax credit?