Divine and Dedicated Tax Solution L.C. - 2027 Client Intake Form

Divine and Dedicated Tax Solution — 2027 Client Intake Form

REFUND OFFSET — please take a moment before you begin the application to call the Refund Offset number at 1-800-304-3107. This will help you understand if you owe any federal or state agencies.

Returning clients: if there aren't any changes to your information, only fill out the Taxpayer Information section (filing status, name, email, phone, and address) and sign. We will handle the rest for you.

New clients of DDTS (Divine and Dedicated Tax Solution): please fill out the form entirely and provide ALL required documents. Missing documents will delay your process.

To all clients: you understand that Divine and Dedicated Tax Solution will prepare your return on your behalf. You understand that when applying for Holiday Loans and Advances, you are responsible for extra bank fees that will apply. You also understand that if you owe on your tax return, you are still responsible for paying prep fees and any additional fees that apply to your tax return. If the fees are not paid, an automatic withdrawal will be taken from the checking/savings account we have on file.

It's very important to be protected from identity theft. We encourage everyone to protect themselves and their dependent(s) by setting up an account with the IRS at www.irs.gov using ID.me. It helps you keep track of your information, including any notices. We look forward to working with you!

1. Taxpayer Information — About You

Primary Email*

First Name*

Last Name*

Are you a new or returning client?

New client

Returning client

Middle initial

Primary Phone*

Full Address

Occupation

Employment status

Government issued ID type

ID issuing state

ID issue date

ID expiration date

Did you file a tax return last year?

Yes

If yes, who filed it?

2. Spouse Information (if Married Filing Jointly)

Spouse first name

Spouse middle initial

Spouse last name

Spouse phone number

Spouse email

Spouse occupation

Spouse employment status

Spouse government issued ID type

Spouse ID issuing state

Spouse ID issue date

Spouse ID expiration date

3. Dependents

Do you have dependent(s)?

Yes

Can your dependent(s) be claimed by anyone else?

Yes

Is there anyone in your household blind or disabled?

Yes

If yes, who?

Did you pay any daycare expense?

Yes

Did you or your dependents receive a 1098-T form from a post-secondary school?

Yes

If yes, school name

Do you have Health Market Insurance that requires you to have a 1095-A form?

Yes

Do you have mortgage interest (Form 1098)?

Yes

4. Self-Employment

If you are not self-employed, skip to Section 5.

Do you conduct business as a self-employed worker?

Yes

Do you have an EIN number?

Yes

EIN

If you have a business name, what is the name of your business / DBA (Doing Business As)?

Type of service you provide?

How does your business conduct services?

In person

Online

Both

What month and year did you start your business?

Is this a new business?

Yes

How did you receive income from your business?

Cash

Cash App / Zelle / PayPal

Check

Card

Did you receive a 1099-NEC? (documents required)

Yes

How many 1099-NECs?

Total income for the year from your business (exact amount or estimate)

Do you have business expenses?

Yes

Do you keep records?

Yes

List the amount in expenses (in dollar amount, ex. $250.00): Supplies, Advertising, Phone / internet, Rent, Insurance, Equipment / tools, Contract labor, Other

Did you use vehicle expenses?

Yes

Do you have a business vehicle?

Yes

Do you track your business mileage?

Yes

Business miles

Do you have a home deduction from business?

Yes

Square feet used for business, out of total square feet of the home

5. Refund Advances & Banking Information

Would you like to apply for an Advance when the season begins? (up to $9,000.00, subject to bank approval)

Yes

Would you like to apply for a Holiday Loan? (up to $1,000, subject to bank approval)

Yes

Some banks participate in Early Funding for an additional fee charged to the taxpayer ($25). Would you like to participate? (optional)

Yes

Bank name

Account type

Checking

Savings

6. How Did You Hear About Us?

How did you hear about us?

Referral name (who sent you? They may earn a $100 referral reward)

7. Documents You Will Need

Photo ID (front and back), and spouse's if filing jointly
Social Security cards for you, your spouse, and all dependents
All W-2s
1099s (1099-NEC, 1099-K, 1099-G, 1099-R, etc.)
Previous year's tax return (new clients only)
1098-T (college) and 1095-A (Health Market)
Daycare receipts / provider info
Mortgage interest statement (1098)
IP PIN letter, IRS notices, or transcripts
Business income and expense records, mileage log
Proof dependents lived with you (school or medical records, lease)
Voided check or bank info for direct deposit

Please upload your documents securely in your client portal. Do not send your Social Security number, ID, or bank details by regular email or text.

8. 2027 Tax Season Fee Schedule

Tax Preparation – Federal Return (Form 1040)	$200.00
Schedule C (Self-Employment / Business Income)	add $500.00
State Return (each state)	add $75.00
Education Credit – American Opportunity Tax Credit (Form 8863)	add $99.00
Amended Return (Form 1040-X)	$450.00
E-File Fee	$75.00
Transmission Fee	$19.99
Bank Fee (only when your fees are paid from your refund)	$34.99
Early Funding (optional, participating banks)	$25.00

EXAMPLES: W-2 + 1 state = $369.99 paid up front or $404.98 paid from your refund. W-2 + Schedule C + 1 state = $869.99 paid up front or $904.98 paid from your refund.

DISCOUNTS (only ONE discount per return):
• Early Bird – $50 off when your return is filed between January 16 and February 7, 2027.
• New Client – $100 off your first year with Divine and Dedicated.
• Referral Reward – $100 paid to the person who referred you, after your return is filed and fees are paid.

Any applicable discount will be deducted from your fees in our tax software when your return is prepared, so your fee total will already reflect it.

Our fees are flat fees based on the forms on your return, never on the size of your refund. Preparation fees are the same whether you pay up front or have fees taken from your refund.

Which discount are you requesting? (One per return)

Early Bird

New Client

None

9. Consent to Use of Tax Return Information

Please read the consent below. Signing it is optional — it is not required for us to prepare your return.

Duration of consent (if blank, one year from the date signed)

Consent to Use of Tax Return Information (optional)

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

You are not required to complete this form to engage our tax return preparation services. If we obtain your signature on this form by conditioning our tax return preparation 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 from the date of signature.

For your convenience, we have entered into an arrangement with third parties to provide qualifying taxpayers with the opportunity to apply for an Electronic Refund Disbursement Service and/or Loan product. To determine whether these products may be available to you, we will need to use your tax return information in order to calculate the amount of your anticipated refund. By signing below, you authorize Divine and Dedicated Tax Solution L.C. to use the information you provide during the preparation of your tax return to determine whether to present you with the opportunity to apply for these products and services.

If you believe your tax return information has been disclosed or used improperly in a manner unauthorized by law or without your permission, you may contact the Treasury Inspector General for Tax Administration (TIGTA) by telephone at 1-800-366-4484, or by email at complaints@tigta.treas.gov.

10. Fee Agreement, Acknowledgement & Signature

Fee Agreement & Acknowledgement (required)

Fee Agreement: I have read and agree to the 2027 Fee Schedule. I understand my fees are based on the forms on my return, each state return is $75.00, the Education Credit (AOTC) is $99.00, an amended return is $450.00, the E-File Fee ($75.00) and Transmission Fee ($19.99) apply to my return, the Bank Fee ($34.99) applies if my fees are paid from my refund, only one discount applies per return, and any applicable discount will be deducted from my fees in the tax software when my return is prepared.

Acknowledgement: By signing below, I confirm that the information I provided on this form is true, correct, and complete to the best of my knowledge. I understand that Divine and Dedicated Tax Solution L.C. will prepare my return based on the information and documents I provide, and that I am responsible for the accuracy of that information. I understand the terms above regarding Holiday Loans, Advances, bank fees, and the payment of preparation fees.

If filing jointly, your spouse will also sign your return documents (Form 8879) before filing.