Client Intake & Consent Form

Richman Elite Financial & Realty Services (REFRS)

“Where Purpose Fuels Prosperity and Legacy Lasts Forever.”

📞 (407) 587-6476 | 🌐 WWW.REFRS.NET 📧 [email protected]

TAXPAYER INFORMATION:

Primary Taxpayer Full Name *

Primary Taxpayer Date of birth *

Primary Taxpayer Phone Number *

Primary Taxpayer Email *

Primary Taxpayer Occupation

Primary Tax Preparer Employment Status

Primary Taxpayer Preferred Contact Method *

Address

Primary Taxpayer Adress *

City

State

Country

Postal code

Are you a full-time student?

Yes

Are you totally and permanently disabled?

Yes

Are you legally blind?

Yes

SPOUSAL INFORMATION

Spouse Full Name *

Spouse Date Of Birth *

Spouse Phone Number *

Spouse Email Address *

Months Lived with Spouse(Months separated, if applicable)

Spouse Occupation

Preferred Spouse Contact Method

Spouse Address *

Street Address
City
State/Province
Postal/Zip Code

Spouse Address

Are they a full-time student?

Yes

Are they totally and permanently disabled?

Yes

Are they legally blind?

Yes

Are they your dependent?

Yes

DEPENDANTS:

Enter your dependents here

Name, DOB, SOCIAL Number, Relationship to Client, & Months Lived with Client
Name, DOB, SOCIAl Number, Relationship to Client & Months Lived with Client
Name, DOB, SOCIAl Number, Relationship to Client & Months Lived with Client
Name, DOB, SOCIAl Number, Relationship to Client & Months Lived with Client
Name, DOB, SOCIAl Number, Relationship to Client & Months Lived with Client
Name, DOB, SOCIAL Relationship to ClientName, DOB, SOCIAl Number, Relationship to Client & Months Lived with Client

Spouse Employment Status

Are you contributing to 401k or other pre-tax account?

Yes

My Spouse As Well

Is this your first time opening a pre-tax account?

Yes

First Time For Us Both

Are you currently renting?

Yes

Looking to buy soon. Tired of paying rent .

Tax Documents Provided *

File Upload *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 20 Files )

Terms & Conditions *

I understand that if I had Marketplace health insurance (Form 1095-A) and do not provide this form, my tax return cannot be filed. I agree to provide Form 1095-A if it applies to me.

Did you or anyone in your household have Marketplace health insurance (Healthcare.gov) in 2025?”

Other Documents Description

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 4 Files )

Do you and your spouse have the same bank account? *

Account Type *

ACKNOWLEDGMENT & SIGNATURE

Representation and Audit Support *

Authorization to Prepare and File *

I agree to {terms & conditions}. Authorization to Prepare & File I hereby authorize Richman Elite Financial & Realty Services (REFRS) and its authorized preparers to prepare and electronically file my federal and state income tax returns using the information I have provided. I understand that my return will not be filed until I review and sign Form 8879 (IRS E-File Signature Authorization).

Refund and Payment Acknowledgment type: I agree to {terms & conditions}. I acknowledge that all fees are due at the time of service and that REFRS maintains a no-refund policy for services rendered. If I elect to use a refund transfer or bank product, I understand that all applicable fees will be automatically deducted from my refund upon disbursement.

Responsibility for Accuracy: I agree to {terms & conditions}. Responsibility for Accuracy I confirm that all information I have provided is true, complete, and accurate to the best of my knowledge. I understand that I am solely responsible for the accuracy of the information provided and that REFRS will not be held liable for errors resulting from incorrect or incomplete information.

Communication Consent type: I agree to {terms & conditions}. Communication Consent By signing this form, I consent to receive communications from REFRS via text, phone, and email, including appointment reminders, document requests, and service updates. I understand that REFRS may use encrypted platforms to send and receive tax documents securely.

Data Privacy and Confidentiality: I agree to {terms & conditions}. Data Privacy & Confidentiality REFRS complies with IRS Publication 4557 and Circular 230 standards. All personal and financial data will be handled with strict confidentiality and stored securely. My information will never be sold or shared with third parties without my written consent.

Consent for Record Retention Type: I agree to {terms & conditions}. I authorize REFRS to retain copies of my documents and tax returns for seven (7) years in accordance with IRS guidelines. I may request copies within this period for a nominal administrative fee.

I confirmed that all information I entered here is accurate and true. I allow REFRS to capture my sensitive data like personal id, government id, social security number (SSN), and other information. I have read the terms and conditions and privacy policy of REFRS By signing below, you acknowledge that you have read and understood your responsibilities and our response confirmed that all information I entered here is accurate and true. allow REFRS to capture my sensitive data like personal id, government id, social security number (SSN), and other information. I have read the terms and conditions and privacy policy of REFRS. By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return. I confirmed that all information I entered here is accurate and true.I allow REFRS to capture my sensitive data like personal id, government id, social security number (SSN), and other information.I have read the terms and conditions and privacy policy of REFRS By signing below, you acknowledge that you have read and understood your responsibilities and our responsibilities in doing this tax return. Abilities in doing this tax return.

Date of Primary Taxpayer Signature

Taxpayer Signature

Clear

Date of Spouse Signature

Spouse Signature Box

Clear

I agree to terms & conditions provided by the REFRS. By providing my phone number, I agree to receive text messages from the business.