Individual Intake Form

IMPORTANT: UPON COMPLETION OF ALL APPLICABLE PARTS OF THIS FORM YOU MUST CLICK THE "SUBMIT" BUTTON AT THE BOTTOM OF THE FORM TO SEND THIS INFO TO OUR OFFICE. CLOSING YOUR BROWSER BEFORE CLICKING THE "SUBMIT" BUTTON WILL DELETE ALL INFO WITHOUT SENDING TO US. IT SHOULD BE NOTED THAT UPON CLICKING THE SUBMIT BUTTON YOU WILL GET A CONFIRMATION EMAIL THAT WE RECEIVED YOUR INFO.

Please also note that to comply with federal and state identity theft protection efforts our firm will ask for a valid state issued photo identification card during your engagement.

***The page is highly secure. We use industry-leading technology Secured Socket Layer (SSL) to keep your information safe. All sensitive information are securely transmitted and can not be compromised.

This questionnaire has been divided into sections and may take you upto 30 minutes to complete. Organize all your tax documents and save yourself the hassle of having to come to our location to get your taxes done.

By providing your phone number you consent to receive text messages from Above All Business Solutions regarding your inquiries, account updates, and other relevant information. Message frequency will vary. Message and data rates may apply. For assistance, reply HELP or contact [email protected]. To stop receiving messages, reply STOP. No further messages will be sent. For details, see our Privacy Policy.

Full Name *

Spouse Full Name

City *

Address *

Phone *

State *

Email *

Occupation *

Does any of these apply?

Deceased

Blind

Can be claimed as dependant

Postal code

Date of birth *

Date of death

Social Security Number *

Social Security Card

Driver's license *

Upload your Driver's License (front and back, not expired)

Dependent #1 Full Name *

Dependent Date of Birth *

Dependent Social Security Number *

Dependent #1 Relationship *

Dependent #2 Full Name

Dependent #2 Date of Birth

Dependent #2 Social Security Number

Dependent #2 Relationship

Dependent #3 Full Name

Dependent #3 Date of Birth

Dependent #3 Social Security Number

Dependent #3 Relationship

Dependent Social Security

Please upload a copy of the dependents social security cards OR other document that has SSN on it. (Please take clear pics. If you were a last year client and filing the SAME dependent, you do not need to upload anything.)

Are you filing a business/self employed/side job/cash job? If yes, describe the nature.

Type of Income

Income Documents

Upload your income document(s) (We need the entire form, with all numbers showing. Please take clear pictures.)

Did you or your family have health insurance at any time in 2021 FROM THE MARKETPLACE? HEALTHCARE.GOV * *

Yes

1095A

Upload the 1095A

Would you like to apply for the advance up to $6000? (It all depends on the amount of your refund) Also Republic Bank is does something different. Instead of denying some people they are counter offering an advance for a lower amount. If this does happens I just want you to know your refund will still go into the place you requested initially. Amounts are:

$6000 - $189.36 fee Refund must be at least $7000

$4500 - $142.02 fee Refund must be at least $5500

$3000 - $94.68 fee Refund must be at least $4000

$2000 - $63.12 fee Refund must be at least $3000

$1500 - $47.34 fee Refund must be at least $2000

$1000 - $31.56 fee Refund must be at least $2000

$500 - $15.78 fee Refund must be at least $500

How would you like your refund? *

Bank Name

Account Number

Routing Number

ENGAGEMENT LETTER AND CONSENT FORM SECTION

CLIENT ENGAGEMENT LETTER

Please sign indicating agreement with the above engagement letter

Engagement Letter Signature *

Clear

CONSENT TO USE OF TAX RETURN INFORMATION

Please sign to indicate you give consent as spelled out above

Consent to use of Tax return Signature *

Clear

CONSENT FOR PAYMENT FORM

Please sign to indicate you give consent as spelled out above

Payment consent form Signature *

Clear

***YOU MUST HIT SUBMIT AND GET THE COMPLETED MESSAGE OR THE FORM WILL NOT GO THROUGH!!