Consent to Use Form

CONSENT TO USE OF TAX RETURN INFORMATION

Federal law requires this consent form be provided to you. Unless authorized by law, we cannot use, without your consent, your tax return information for purposes rather than the preparation and filing of your tax return.

You are not required to complete this form. If we obtain your signature on this form by conditioning our services on your consent, your consent will not be valid. Your consent is valid for the amount of time that you specify. If you do not specify the duration of your consent, your consent is valid for one year.

For your convenience, we have entered into arrangements with certain financial institutions and their partners regarding the provision of bank accounts, refund settlement products, card services, and/or related banking services. To determine whether these services may be of interest to you, we will need to use your tax return information.

If you sign this form and check the box below, you authorize us to use your (please indicate the tax year on the space provided above) tax return for the designated purposes.

I authorize Fresh Start to use my (please indicate the tax year on the space provided above) Tax Return and Information collected during the preparation of my taxes to ensure that any refund settlement products, and related banking services that I obtain or apply can be issued, processed, underwritten, and serviced. The foregoing activities and related services may be performed by one of the following companies and/or their affiliates.