MyMaxBack Tax Client Intake Form

* Indicates required fields.
Type of Client
Referred by:
If you were referred to me by someone, please enter their name and number to ensure they receive their referral fee.
Name

Example: Jr, IV, III ...etc.
CURRENT Address

Street Address

APT #

CityState

Zip Code
Date of Birth

MonthDayYear
Date
SSN
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

- Dependent # 1 Name
  
  FirstLastSuffix (Jr.,III, IV..etc)
- Date of Birth
  
  MonthDayYear
  Birthday
- SSN
  SSN#
- Relationship to You
  Ex: Son, Daughter, Parent, Grandparent…
- Dependent # 2 Name
  
  First NameLast NameSuffix
- Date of Birth
  
  MonthDayYear
- SSN
- Relationship to You
  Ex: Son, Daughter, Parent, Grandparent…
- Dependent # 3 Name
  
  First NameLast NameSuffix
- Date of Birth
  
  MonthDayYear
  Date
- SSN
- Relationship to You
  Ex: Son, Daughter, Parent, Grandparent…
- Do you have more than three dependents?
- Please enter the dependents Name/SSN/Date of Birth & Your Relationship to the Dependent:
- Please upload a copy of the dependent(s) birth certificate(s) and social security card(s) OR other document that has SSN on it.
  
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- Do you have any expenses for child care?
- Do any of your dependents have tuition expenses?

- Did you purchase insurance from OR have any premium credits from the insurance company you use?
- If you have Insurance through your job (1095B) or Insurance through your state (Medicaid) (1095C) You do not need to upload them. We only require you to upload the 1095A form.
- Upload 1095A
  
  Cancelof

Business Name (if different from your name)
Business EIN (if you don't use your SSN)
How did you receive payments from your clients/customers?
TOTAL Business Income
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Total Expenses
Select all that apply to you:

Rows	Amount
Advertising
Repair & Maintenance
Auto Expense
Supplies
Commissions
Taxes & Licenses
Contractor Labor
Travel Mileage
Depletion
Meals
Interest Mortgage
Utilities
Legal & Professional
Office Expenses
Rent or Lease

- Would you like to apply for the tax advance loan of up to $7,000? (The amount you are approved for depends on the amount of your refund).
  
  Regardless of the method you select to receive your tax refund advance, your refund will be processed the same way. Please note, this choice cannot be changed, even if your advance is not approved.
  
  Approval rate is about 79% and the bank will look at your refund history from previous year to determine approval. 4 out of 5 of my clients are usually approved.
  
  **DISCLAIMER: DESPITE ODDS, REFUND ADVANCES ARE NOT GUARANTEED
  
  THE BANK CAN APPROVE YOU FOR THE AMOUNT REQUESTED, DENY YOU, OR APPROVE YOU FOR A LESSER AMOUNT**
- Would you like to apply?
- How would you like to receive your tax refund advance loan?
- Acknowledgment

- How would you like to receive your refund?
- Bank Account Type
- Name of Your Bank
- Routing Number
- Account Number
- What was your Refund amount last year?
- Do you plan on buying a house in the next two years?
- Do you plan on filing Bankruptcy?

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• Access to credit-building tools and resources
• 24/7 customer support throughout the process
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Disclosure: All clients are required to purchase credit monitoring at 26.00/ a month through Smart credit. This allows us to pull your updated credit report every month. Without credit monitoring , we will not be able to access your report , send updates, or proceed with your service!!!

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- Tax Preparation Engagement & Service Agreement
  
  This Agreement is between the undersigned Client (“Client”) and KLBP LLC d/b/a My Max Back Tax & Financial Services (“Preparer”). By signing below, the Client authorizes the Preparer to prepare tax return(s) and agrees to the following terms.
  
  1. Accuracy of Information
  
  The Client affirms that all information provided to KLBP LLC d/b/a My Max Back Tax & Financial Services is true, complete, and accurate to the best of their knowledge. The Client must retain supporting documentation for all items reported. Knowingly providing false information may constitute tax fraud and could result in fines, restitution, court proceedings, and/or imprisonment.
  
  2. Client Responsibilities
  
  The Client agrees to provide all income, deduction, and expense documents needed to prepare an accurate return. If additional documents or information are received after preparation begins, the Client must notify KLBP LLC d/b/a My Max Back Tax & Financial Services immediately so we can update the return prior to filing.
  
  The Client affirms that:
  - All income, expenses, and deduction amounts provided are accurate.
  - They possess written records to substantiate every item reported.
  - If audited by the IRS or a state tax authority, the Client must provide those records. KLBP LLC d/b/a My Max Back Tax & Financial Services may advise on acceptable evidence but is not responsible for maintaining the Client’s records.
  3. Limitation of Responsibility
  
  KLBP LLC d/b/a My Max Back Tax & Financial Services will prepare returns based solely on the information provided by the Client. KLBP LLC d/b/a My Max Back Tax & Financial Services and its preparers are not responsible for errors, penalties, or interest resulting from incomplete, inaccurate, or false information supplied by the Client. The Client waives all claims against KLBP LLC d/b/a My Max Back Tax & Financial Services and its preparers for such errors.
  
  4. Authorization & Signatures
  
  By signing, the Client authorizes KLBP LLC d/b/a My Max Back Tax & Financial Services to prepare, sign (when authorized), and file federal and state tax returns on their behalf. The Client’s signature on this Agreement may be used where appropriate on IRS Forms 1040, 8879, 7216, and any other documents required to complete the tax return(s).
  
  The Client also authorizes KLBP LLC d/b/a My Max Back Tax & Financial Services to send service updates, appointment reminders, and related communications via text and/or email.
  
  5. Data Privacy & Consent
  
  By signing this Agreement, the Client:
  - Confirms the accuracy of the information provided.
  - Authorizes KLBP LLC d/b/a My Max Back Tax & Financial Services to securely collect, use, and retain personal information (including government ID, Social Security Number, and banking information) necessary to prepare and file tax returns.
  - Acknowledges they have read and agree to the Preparer’s Terms & Conditions and Privacy Policy.
  - Consents to the use of their personal information solely for tax preparation, filing, verification, and compliance.
  6. Fees, Invoicing & Payment
  
  Fees for tax preparation are due upon presentation of the invoice. The Client is responsible for all fees for services rendered by KLBP LLC d/b/a My Max Back Tax & Financial Services, regardless of refund delays, refund reductions, or refund issuance by check.
  
  If the invoice remains unpaid, KLBP LLC d/b/a My Max Back Tax & Financial Services reserves the right to:
  
  (a) debit the Client’s bank account on file for the outstanding balance;
  
  (b) assign the account to a collection agency; and/or
  
  (c) pursue legal action to recover the debt.
  
  The Client agrees not to dispute charges for services rendered on the basis of IRS processing delays or refund adjustments.
  
  7. Processing Fee Acknowledgment
  
  The Client agrees that KLBP LLC d/b/a My Max Back Tax & Financial Services may charge a $75 processing fee to the bank account on file under the following conditions:
  1. The return is rejected because the Client already filed or applied for a tax advance with another provider.
  2. The return is completed, but the Client fails to sign within 24 hours of notification; in such case, KLBP LLC d/b/a My Max Back Tax & Financial Services may assume the Client filed elsewhere and deactivate the return.
  8. Amendments & Additional Fees
  
  If an amended return is required because the Client did not provide all income documents or other required information prior to filing, the Client agrees to pay the applicable amendment preparation fee upfront before the amended return is transmitted to the IRS/state. The Client understands that no amended return will be filed until the amendment fee is paid in full, and any delay caused by nonpayment is the Client’s responsibility.
  
  9. Record Retention
  
  Original documents will be returned to the Client. KLBP LLC d/b/a My Max Back Tax & Financial Services retains digital copies of tax returns and working papers for three (3) years, after which they will be permanently deleted. Paper copies may be requested for an additional fee.
  
  10. Engagement Conclusion & Client Review
  
  The engagement concludes when the completed return is delivered for paper filing or when the Client’s signature is obtained and the return is electronically filed. If the Client declines e-filing, the Client is solely responsible for timely submission to the IRS and/or state agencies. The Client agrees to review all tax documents carefully prior to signing.
  
  11. Theft of Services, Collections & Legal Costs
  
  Failure to pay for services rendered may constitute Theft of Services under applicable law. KLBP LLC d/b/a My Max Back Tax & Financial Services reserves the right to seek payment through account debit, collections, and/or court action. The Client agrees to be liable for any reasonable attorney’s fees, court costs, and collection expenses incurred in recovering unpaid balances.
  
  12. Applicability to Preparers, Contractors & Affiliates
  
  The Client understands and agrees that this Agreement applies to services provided by KLBP LLC d/b/a My Max Back Tax & Financial Services and its authorized preparers, contractors, and affiliates. This Agreement binds the Client regardless of which authorized preparer performs the work.
  
  Client Acknowledgment & Signature
  
  By signing below, I confirm that I have read, understand, and agree to the terms above. I authorize KLBP LLC d/b/a My Max Back Tax & Financial Services to prepare and file my tax return(s) and to use my information as described.
- Taxpayer Signature
- Taxpayer Full Name
  
  First NameLast Name
- Date Signed
  
  MonthDayYear
  Date
- Spouse Signature
- Date Signed
  
  MonthDayYear
  Date
- Should be Empty: