NOTICE:

• Required Documents: Attach ALL income statements, Social Security cards, and/or state-issued IDs to this form.

• Important: Missing documents may cause delays or cancellation of your submission.

• Submission Method: Do not email documents. A secure link will be provided for any additional uploads.

Thank you!

Specify the tax year on the form. • Attach documents for the stated tax year only. • Use a separate form for each tax year. *

Filing Status

TaxPayer's Full Name *

Taxpayer's Date of Birth *

Taxpayer's Social Security # *

Taxpayer's FULL Address (city, state, zip code, county) *

Is this an amendment? *

Yes

Is this a new address with the IRS? *

Yes

Can another taxpayer claim you as a dependent on their tax return? *

Yes

Will you be filing a tax return with your spouse? *

Yes

Spouse's First & Last Name

Spouse's Date of Birth

Spouse's Social Security Number

How many Dependents are you claiming? *

Dependent 1: First & Last Name

Dependent 1: Date Of Birth

Dependent 1: Social Security Number

Dependent 1: Social Security Card

Dependent 1: Relationship

Dependent 1: # of months this person lived in your home

Dependent 2: First & Last Name

Dependent 2: Date Of Birth

Dependent 2: Social Security Number

Dependent 2: Social Security Card

Dependent 2: Relationship

Dependent 2: # of months this person lived in your home (Tax Year)

Dependent 3: First Name & Last Name

Dependent 3: Date Of Birth

Dependent 3: Social Security Number

Dependent 3: Social Security Card

Dependent 3: Relationship

Dependent 3: # of months this person lived in your home (Tax Year)

Dependent 4: First & Last Name

Dependent 4: Date Of Birth

Dependent 4: Social Security Number

Dependent 4: Social Security Card

Dependent 4: Relationship

Dependent 4: # of months this person lived in your home (Tax Year)

Dependent 5: First & Last Name

Dependent 5: Date Of Birth

Dependent 5: Social Security Card

Do you have an IRS IP PIN? *

Yes

Do you owe debt to any Government Agency; such as IRS, Student Loans, Child Support etc? *

Yes

Did you receive health insurance through the Market Place? *

Yes

Did you or your spouse receive unemployment benefits ? *

Yes

Did you or your spouse make payments on your student loans ? *

Yes

Did you, your spouse or any dependents attend college ? *

Yes

Did you pay any child care expenses for any dependents listed above? *

Yes

If you OWN your home, have you received form 1098 from your mortgage lender? *

Yes

Are you self employed or a business owner? *

Yes

Upload your Profit & Loss (P&L) or Income & Expense Statement

Are you interested in the SAME DAY Advance up to $7,000 with bank approval? *

Yes

Are you interested in Audit Protection for your tax return? ($79 Fee) *

Yes

Do you have a copy of your tax return from last year? *

Yes

Copy of last year return ALL pages

Do you have W2,1099,1098-T, Etc? (if Yes please use the next box(s) below to upload docs *

Yes

1. Tax Document (W2, 1099, 1098-T, Etc)

2. Tax Document (W2, 1099, 1098-T, Etc)

3. Tax Document (W2, 1099, 1098-T, Etc)

4. Tax Document (W2, 1099, 1098-T, Etc)

Tax Payer Social Security Card

Driver License/ State ID *

PLEASE PUT ACCOUNT AND ROUTING NUMBER IN TWICE TO MAKE SURE WE HAVE THE CORRECT NUMBERS

Refund Dispersement Method *

What type of Bank account are you using? *

Checking

Savings

Verify Routing Number *

Bank Account Number *

Verify Bank Account Number *

Would you be interested in exploring any additional business or personal services we offer?” *

Most Recent Photo of Yourself *

Spouse Signature (If Applicable)

Clear

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Client Intake Form