JR Tax & Wealth Solutions

How did you hear about us?
If someone referred you, please type his or her name here.
Are you interested in becoming a Tax Professional ?
Are you buying a new home within the next 2 years?
Are you interested in Credit Repair
Are you interested in applying for a cash advance on your tax refund?
Are you purchasing a car in the next 3 months?
Email
example@example.com
Taxpayer's Name

First NameLast Name
Taxpayer's Phone Number
Example: xxx-xxx-xxxx
Are you self employed?
Taxpayer's Job Title
Taxpayer's Date of Birth
Example: 01/01/2001
Taxpayer's SSN
Example: xxx-xx-xxxx
- Spouse's Full Name
  First Name
- Spouse's SSN
  Example: xxx-xx-xxxx
- Name
  
  First NameLast Name
- Spouse's Date of Birth
  Example: 01/01/2001
- Spouse's Phone Number
  Example: xxx-xxx-xxxx
- Spouse's Email Address
  Example: example@example.com
- Spouse's Job Title
  example@example.com
- Home Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Did you and your spouse live apart during the year?
- If you were married, did you live together at any time after June 30, 2026?
- What is your marital status as of December
- Did you pay over half the expenses of maintaining your residence for the entire year?
- Did you support a child or family member for more than 6 months out of the year?
- Are you on any Government Assistance
- How many dependents are you claiming?
- Dependent #1
  
  First NameLast Name
- Dependent #1 Date of Birth
  01/01/2001
- Dependent #1 SSN
- What is Dependent #1's Relationship to you (son, daughter, etc.)?
- How many months did Dependent #1 live with you in 2026? (If all year, enter 12)
- Dependent #2
  
  First NameLast Name
- Dependent #2 Date of Birth
  Example: 01/01/2001
- Dependent #2 SSN
- How many months did Dependent #2 live with you in 2026? (If all year, enter 12)
- What is Dependent #2's Relationship to you (son, daughter, etc.)?
- Dependent #3
  
  First NameLast Name
- Dependent #3's Date of Birth
  01/01/2001
- Dependent #3s SSN
  Example: xxx-xx-xxxx
- How many months did Dependent #3 live with you in 2026? (If all year, enter 12)
- What is Dependent #3's Relationship to you (son, daughter, etc.)?
- Dependent #4's First Name
  First Name
- Dependent #4's Last Name
  Last Name
- Dependent #4's Date of Birth
  01/01/2001
- Dependent #4's SSN
  Example: xxx-xx-xxxx
- What is Dependent #4's Relationship to you (son, daughter, etc.)?
- How many months did Dependent #4 live with you in 2026? (If all year, enter 12)
- Dependent #5's First Name
  First Name
- Dependent #5's Last Name
  Last Name
- Dependent #5's Date of Birth
  01/01/2001
- Dependent #5's SSN
  Example: xxx-xx-xxxx
- What is Dependent #5's Relationship to you (son, daughter, etc.)?
- How many months did Dependent #5 live with you in 2026? (If all year, enter 12)
- Are there any dependents in daycare? If yes, please be prepared to submit the provider's information
- How would you like to receive your tax refund?
- How would you like to pay for your tax return?
- How would you like to receive your refund?
- Name of Bank
- Routing Number (Direct Deposit)
- Bank Account Number (Direct Deposit)
- Can someone else claim you as a dependent?
- Did you have health insurance for the entire year?
- Who was your insurance coverage through in 2026?
- Was your insurance through Medicaid?
- Was your insurance through the Affordable Care Act (The Marketplace)?
- Did your dependents have health insurance for the entire year?
- Was YOUR DEPENDENTS' insurance through Medicaid?
- Was YOUR DEPENDENTS' insurance through the Affordable Care Act (The Marketplace)?
- Have you ever been denied the Earned Income Tax Credit (EITC)?
- Were you or any of your dependents in college in 2026?
- If so, Do you have a 1098-T Form for either you or your dependents?
- Did you trade any Virtual Currency
- Are you interested in AUDIT PROTECTION?
- Client Acknowledgment and Tax Preparation Request
  
  I request tax preparation services from J&R Tax & Wealth Solutions. I confirm that the information and documents I provide are accurate and complete to the best of my knowledge. I agree to answer follow-up questions, provide supporting information when requested, and promptly report any errors or changes.
  
  I am responsible for the information and documents I provide. I understand that inaccurate, incomplete, or omitted information may result in additional taxes, interest, penalties, or corrections to my return. This acknowledgment does not relieve J&R Tax & Wealth Solutions of its obligations under applicable law.
  
  I understand that submitting this intake form does not authorize anyone to sign or file my tax return on my behalf. Before filing, I will review my completed return, including any direct-deposit information, and separately complete the required signatures and filing authorizations.
  
  Refund advances and other refund-related bank products are optional and subject to the provider’s terms and approval. This acknowledgment does not authorize an application for those products. Any required applications, agreements, or consents to use or disclose my tax information will be handled separately.
  
  No specific refund amount, refund date, or loan approval is guaranteed.
  
  By entering my name and date below, I acknowledge that I have read and understand this statement.
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Type Name to Sign and Acknowledge
- Should be Empty: