Truck Driver Tax Season VIP Sign-Up Form
Please complete this form to enroll in our VIP Truck Driver Tax Services. All information is confidential and used solely for tax preparation and consulting purposes.
Section 1: Individual Information
Full Legal Name:
Preferred Name (if different):
Social Security Number (Last 4 Digits):
Date of Birth (MM/DD/YYYY):
-
Month
-
Day
Year
Date
Marital Status:
Single
Married
Head of Household
Divorced
Widowed
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Preferred Method of Contact:
Phone
Text
Email
Section 2: Address Information
Street Address:
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is this your current mailing address?
Yes
No
Mailing Address (if different):
Section 3: Filing & Employment Information
Tax Filing Year:
Primary Occupation:
Company Driver
Owner-Operator
Lease Operator
Dispatcher
Other
Do you receive a W-2, 1099, or both?
W-2
1099
Both
Trucking Company / Business Name (if applicable):
Back
Next
Section 4: VIP Tax Services Selection
Please select the services you are interested in:
Please select the services you are interested in:
VIP Tax Preparation
Audit Protection
Year-Round Tax Support
Business Consulting
Expense Tracking Assistance
Prior-Year Tax Review
Tax Planning for Next Year
Section 5: Additional Information
Have you filed taxes as a truck driver before?
Yes
No
Do you currently owe back taxes or are you on a payment plan?
Yes
No
Additional Notes or Questions:
Section 6: Acknowledgement & Disclosure (A & D)
Please read and acknowledge the following statements by initialing next to each item:
A. Accuracy of Information
I acknowledge that all information I have provided is true, correct, and complete to the best of my knowledge. I understand that Empower Consulting Group LLCrelies on the
information I provide and is not responsible for errors or omissions resulting from incomplete, inaccurate, or withheld information.
Client Initials (A):
D. Disclosure, Consent & IRS Compliance
I authorize Empower Consulting Group LLC to use the information provided for the purpose of tax preparation, tax planning, tax consulting, and related advisory services. I
understand that my information will be kept confidential in accordance with IRS regulations and applicable laws, and disclosed only as required by law or with my written consent. I
further acknowledge that tax results are not guaranteed and may be affected by IRS review, audit, or changes in tax law.
Client Initials (D):
I acknowledge and agree to the A & D statements above.
Section 7: VIP Service Scope & Non-Refund Disclosure
I understand that VIP services provided by Empower Consulting Group LLC may include tax preparation, consulting, planning, audit support guidance, and administrative
assistance. VIP services do not guarantee refunds, specific tax outcomes, or protection from IRS audits. Fees paid for services are for professional time and expertise and are
non-refundable once services have begun.
Client Initials (VIP):
Section 8: Client Agreement & Signature
By signing below, I confirm that I have reviewed and agree to the Acknowledgement & Disclosure (A & D) and VIP Service Scope above. I certify that the information provided is
accurate to the best of my knowledge and that I am requesting professional services from Empower Consulting Group LLC.
Client Signature:
Printed Name:
Date:
-
Month
-
Day
Year
Date
Empower Consulting Group LLC
Professional Tax & Business Consulting Services
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