Divine and Dedicated Tax Solution Client Intake form

Client Intake form

please read and fill out this form. Make sure you sign it, so there isn't any delays.
- Review Stages
- Approvals
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- REFUND OFFSET- please take a moment before you begin the application to call the Refund Offset number at 1-800-304-3107, this will help understand if you owe any federal or state agencies.
  
  For all returning clients, we are on a new form, if there isn't any changes to your information only fill out the Taxpayer Information Section(filing status, name, email, phone, and address) and sign, we will handle the rest for you.
  
  New Clients of DDTS(Divine and Dedicated Tax Solution) please make sure to fill out the form entirely, please make sure to upload ALL required documents.(not uploading documents will delay your process.)
  
  To all clients, you do understand that Divine and Dedicated Tax Solution will prepare your return on your behalf. You understand that when applying for Holiday Loans, and Advances you are responsible for extra bank fees that will apply. You also understand that if you owe a tax refund you are still responsible for paying for prep fees and any additional fees that is applicable to your tax return. If the fees are not paid an automatic withdrawal will be taken from the checking/saving account that we have on file with us.
  
  It's very important to be protected from Identity Theft.We encourage all to protect themselves and dependent(s) if applicable by setting up an account with the IRS at www.irs.gov. You can create an account with the idme(follow the simple steps to creating this account.) It helps to keep a track with your information including any notices.
  
  We look forward to working with you in the future.
- Are you a New/Returning Client?
- Referral Name
- Would you like to apply for an Advance when the season begins? up to $9,000.00
- Refund Advance Routing Notes (Staff Use Only)
- Filing Status
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Date of Birth
  monthdayyear
- Social Security Number
- Name
  
  First NameLast Name
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Government Issued ID?
- State ID/ Driver License Number
  EX.999999999 -DL,STATE ID, PASSPORT,ETC.
- ISSUE DATE
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- EXPIRATION DATE
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Employment Status
- Occupation
- Employment Status
- Occupation
- Name
  
  First NameLast Name
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Email
  example@example.com
- Social Security Number
- Government Issued ID
- Government Issued Number
- Issuing Date
- Expiration Date
- Did you file a Tax Return last year?
- Do you/dependent use a IP Pin?(this is a 6-digit number that is generated by the IRS to protect you information.)
- IP Pin Number
- IP Pin Number (dependent if applicable)
- Is there anyone in your household blind or disable?
- Do you have Health Market Insurance that requires you to have a 1095-A form?
- Do you have dependent(s)?
- Can your dependents(s) be claimed by anyone else?
- Did you pay any daycare expense?
- Do you conduct business as a self-employed worker?
- Do you have a EIN NUMBER
- Do you Have a Business Name?
- If yes, What is the Name of your Business/DBA(Doing Business As)?
- Type of Service you provide?
- How do your business conduct services?(if applicable)
- What month and year did you start your business?
- Is this a new business?
- How did you receive Income from your Business?
- Do you keep Records?
- Did you receive a 1099-NEC?(documents required)
- Total Income for the year(from business, please enter the exact amount, estimate)
- Do you have Business Expense?
- List the amount in Expenses below(in dollar amount. ex.$250.00)
- Did you use vehicle expenses?
- Do you have a business vehicle?
- Do you track your business Mileage?
- Do you have home deduction from business?
- Did you or your dependents received a 1098-T form from a post-secondary school?
- Previous Tax Return(New Clients Only)
  
  Cancelof
- Health Information( 1095-A form 1095-C)
  
  Cancelof
- Day Care Information(if Applicable)
  
  Cancelof
- Post-Secondary School(if Applicable)
  
  Cancelof
- Mortgage Interest(If Applicable)
  
  Cancelof
- Business, 1099,W-2, ETC
  
  Cancelof
- Misc. Doc(Ip Pin, IRS Notices, Transcripts,etc.)
  
  Cancelof
- Some banks participate in Early Funding for an additional fee is charged to the taxpayer($25). Would you like to participate?(optional)
- Bank Name
- Routing Number
- Account Number
- Account Number(repeat)
- Appointment- NEW CLIENTS {ONLY NEW CLIENTS}
- Signature
- Spouse(if Applicable)
- EXPIRATION DATE
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use your tax return information for purposes other than the preparation and filing of your tax return without your consent. You are not required to complete this form to engage in our tax return preparation services. Your consent is valid for one year from the date of signature unless you specify otherwise. If you do not consent, you may still have your tax return prepared and electronically filed by us for a fee. For your convenience, we have entered into an arrangement with third parties to provide qualifying taxpayers with the opportunity to apply for an Electronic Refund Disbursement Service and/or Loan product. To determine whether these products may be available to you, we will need to use your tax return information in order to calculate the amount of your anticipated refund. By signing below, you authorize Divine and Dedicated Tax Solution L.C. to use the information you provide during the preparation of your tax return to determine whether to present you with the opportunity to apply for these products and services.
- Taxpayer Signature - Consent to Use
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Joint Taxpayer Signature
- Joint Taxpayer Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Should be Empty: