Quote Intake Form

Please complete the information as it applies to you and upload your documents. Thank you!

Taxpayer Information

Social Security *

Full Name *

Address *

Address Cont. *

Phone *

Email *

Date of birth *

Occupation

Spouse Information

Full Name

Spouse Address (If Different)

Spouse's Phone Number

Spouse's Date of Birth

Spouse's Date of Death

Spouse's Email

Spouse's Occupation

Please choose a filing status. *

Dependent Information

List Dependents

Refund Advance Option

The loans offered is in amounts of 25%, 50% or 75% of your expected tax refund up to $7000. Some loans are an interest-bearing loan and will have an annual APR. It is a 36% APR on loans over $1,000 up to $7,000. Please confirm the interest rates with your preparer.

Cash Advance via Refund Transfer *

By signing below, I certify all information provided on each form for the completion of my tax return is true, valid, and to the best of my knowledge. I accept full responsibility of the statements mentioned above. All disputes regarding this matter shall be forwarded to me with the information found on my tax returns forms. *

Clear

Date *

Notes