Tax Refund Advances up to $6000

Client Form

Professional tax and business services

Client Form

Full Name

DOB

SSN

Spouse Name

Spouse DOB

Spouse SSN

Address, City, State, Zip

Primary Phone

Spouse Phone

Primary Email

Spouse Email

Primary Occupation

Spouse Occupation

Did you receive unemployment?

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DEPENDENT CARE INFO:

Dependent Name

SSN

DOB

Relationship

Dependent Name

SSN

DOB

Relationship

Dependent Name

SSN

DOB

Relationship

Dependent Name

SSN

DOB

Relationship

Dependent Name

SSN

DOB

Relationship

What documents do you have to prove your child(ren)'s relationship to you?

What documents do you have to prove your child(ren)'s residency?

Care Provider

Provider Address

Provider SSN / EIN

Amount Paid

Care Provider

Provider Address

Provider SSN / EIN

Amount Paid

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SELF EMPLOYED SECTION:

Did you miss work due to Covid related issues for yourself?

Did you miss work due to Covid related issues for someone you care for?

Business or Profession

EIN / SSN

Gross Income

Mileage

Advertising

Vehicle Cost

Wages

Tolls

Insurance

Legal / Professional Fees

Meals & Entertainment

Rent of Property

Rent of Machinery

Office Expenses

Supplies

Repairs

Telephone

Utilities

Postage

Materials

Travel Costs

Other Expense

Sq Ft of Home Used For Business

Total Sq Ft of Homes

Nature of Home Business

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EDUCATIONAL SECTION:

Did You Attend College, What School?

EIN #

1098 Received?

Total Costs in Tax Year

Were You Insured in Current Tax Year?

Please List Everyone Who Was Insured

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BANKING INFO:

Bank Name

Routing Number

Account Number

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UPLOADS:

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How did you hear about us?

Additional Notes

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AUTHORIZATIONS REQUIRED:

I certify the information provided herein is true and actual to the best of our knowledge. Initials and last 4 of social to sign.

I authorize ATM Express Financial And Tax Services to submit my return to the IRS upon completion. Initials and last 4 of social to sign.

I authorize ATM Express Financial And Tax Services to take fee for services from my refund. Initials and last 4 of social to sign.

I waive ATM Express Financial And Tax Services any liability for errors due to incorrect information provided. Initials and last 4 of social to sign.

I authorize ATM Express Financial And Tax Services to contact me by phone, email, postal mail, or text. Initials and last 4 of social to sign.

I understand and agree that I am financially responsible for payment of all services received. I understand ATM Express Financial reserves the right to collect any unpaid balances owed within 30 days of receipt of tax refund release from the Internal Revenue Service. Client agrees to pay ATM Express Financial and Tax Services all tax preparation fees associated with the submission of a file to the IRS for tax payment even if client funds are not disbursed to the client due to any circumstance. Initials and last 4 of social to sign.

I WANT MY MONEY NOW! Apply for an advance here!

(832) 791-2274

Houston, Texas

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