Text7216 – CONSENT TO USE & DISCLOSURE OF TAX RETURN INFORMATION

Tax Fairy (“We”, “Us”, and “Our”) Name of tax preparer Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more than one). Unless authorized by law, we cannot use, without your consent, your tax return information for purposes other than the preparation and filing of your tax return. You are not required to complete this form. Because our ability to disclose your tax return information to another tax return preparer affects the tax return representation service(s) that we provide to you and its (their) cost, we may decline to provide you with the tax return preparation service or change the terms (including the cost) of the tax return preparation services that we provide to you. 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. In order to process your return, we must disclose all of your 2014 tax return information to America’s Tax Office. For your convenience, we have entered into agreements with a bank to provide qualifying taxpayers with the opportunity to apply for a (bank product) Refund Transfer (RT), or Electronic Refund Check or Electronic Refund Deposit. To determine whether these products may be available to you, we will need to use your tax return information by analyzing it and calculating the amount of your anticipated refund. By signing below, you (including each of you if there is more than one taxpayer) authorize us to disclose to America’s Tax Office all of your 2014 tax return information. By signing below, you (including each of you if there is more than one taxpayer) authorize us to use the information you provided to us during the preparation of your 2014 tax return to determine whether to present you with opportunity to apply for bank product (described above) and services.

This serves as a general acknowledgement that I am submitting this information to Tax Fairy to receive an income tax preparation and submission to the IRS on my behalf. I certify that I am responsible for all fees associated with the preparation of my income tax. I do understand that if my refund is large enough the tax preparation fees and bank fees will be deducted from my income tax refund. I also understand that if my refund is not enough to cover the preparation and bank fees, I will be required to pay those fees out of pocket in the form of cash, credit or some other form of electronic payment. If for some reason my electronic payments declines or a charge back is received I understand I will be responsible for any fees associated with Tax Fairy having to re-coup the funds, including administrative, collection and court fees. I also understand if I report the payment for income tax preparation as an unauthorized charge of some sort all charges will be reversed in the favor of Tax Fairy because I am fully aware that I received a complete service. I understand and have been made aware that once an Income Tax return has been prepared and submitted to the IRS there is no way to undo the service provided. By signing my name in the box, I certify that all of the answers to the questions listed above are true and complete to the best of my knowledge.

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