Broadway Tax Solutions LLC contact information:

Monday-Thursday 9:30am-5pm, Friday 9:30am-4pm, and Saturday 10am-3pm (by appointment ONLY).

Website: BroadwayTaxSolutions.com Email: BroadwayTaxSolutions@gmail.com

Address: 1120 East Broadway Ave, West Memphis, AR, 72301 Phone: 901-468-4900

(Please allow up to 24 hours for email responses! Thank you for understanding!)

***Ask about the FAST CASH ADVANCE! It has been extended for an EXTRA 2 WEEKS!***

January 2nd - March 17th !!

***If you are filling out this form, it is to file your federal income taxes!!***

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CLIENT INTAKE FORM

Personal Information

First Name *

Last Name *

Date of Birth * +

IP PIN

Social Security Number *

Phone Number *

Email Address *

Street Address *

Address Line 2

City *

State *

Zip Code *

Country *

Are you a citizen, national, or resident of the US? *

YES

NO NO

Filing Status (Select One) *

Check all that apply: *

Do you receive any of the following (Check all that apply): *

Are you totally or permanently disabled? *

NO

YES (if so, list disability?) YES (if so, list disability?)

Income Information

Occupation *

Do you own or operate a small business or a home based business? *

NO

YES (If so, what kind is it?) YES (If so, what kind is it?)

Do you have a business license? *

NO

YES (if so, enter your EIN) YES (if so, enter your EIN)

Total Gross receipts or sales (if applicable)

Total business expenses for 2021 (if applicable)

Did you receive any Child Tax Credit (CTC) payments in 2021? *

NO

YES (if so, how much?) YES (if so, how much?)

Did you receive an economic impact payment in 2021? *

NO

YES (if so, how much?) YES (if so, how much?)

Did you receive a stimulus payment in 2021? *

NO

YES (if so, how much?) YES (if so, how much?)

Did you receive any unemployment benefits in 2021? *

YES

NO

Were any of your tax credits disallowed or reduced in a previous year? (If so, we will need to complete form 8862 together) *

YES

NO

If you or your dependent(s) attended college, how did you pay? *

Financial Aid

Scholarship

Personal Fianances

N/A

Dependents Information

Number of Dependents *

Did you pay any childcare expenses in 2021? *

NO

YES (if so, how much?) YES (if so, how much?)

Dependents

1.

First Name *

Last Name *

Date of Birth * +

Social Security Number *

Relationship: *

Totally or permanently disabled? *

NO

YES (if so, list disability?) YES (if so, list disability?)

2.

First Name *

Last Name *

Date of Birth * +

Social Security Number *

Relationship: *

Totally or permanently disabled? *

NO

YES (if so, list disability?) YES (if so, list disability?)

3.

First Name *

Last Name *

Date of Birth * +

Social Security Number *

Relationship: *

Totally or permanently disabled? *

NO

YES (if so, list disability?) YES (if so, list disability?)

Did every child/dependent live with you for the majority of 2021? *

YES

NO

Can anyone else claim any of your children/dependents? *

NO

YES, (If so, who?) YES, (If so, who?)

Refund and Banking Options

Would you like to apply for the Fast Cash Advance for up to $6000? *

YES

NO

How would you like to receive yourTax Refund (if you did not opt-in for the Fast Cash Advance)?

Direct Deposit

Pre-Paid Debit Card (Go2bank)

Check

Bank Name (Direct Deposit ONLY)

Account Number

Routing Number

Upload Needed Documentation

Upload your ID and Social Security Card *

Upload your dependent(s) Social Security Card(s)

Upload your W2 or 1099 *

Upload all supporting documentation for your business. (Receipts, Bills, Log Sheets, DBA, Business Cards, Expenses, etc.)

Upload form 1098 if you are claiming (Homeowners) mortgage interest.

Upload form1099-G if you received unemployment benefits.

Upload your College/Tuition documents. (1098T)

Upload any other documentation that could be used to support your claim for a Tax Refund.

Is there any information pertaining to your tax return that we should be aware of?

Disclosure and Consent (Sign Below)

Broadway Tax Solutions LLC is not responsible if the taxpayer provides us with incorrect information (i.e. social security numbers for self, spouse, or dependents, last names, birth dates). This may delay your refund. Broadway Tax Solutions LLC is not responsible for any IRS audits. All information obtained from the taxpayer and/or spouse must be presentable if the IRS audits your tax return. Broadway Tax Solutions LLC is not responsible for any incorrect tax figures provided by the taxpayer and/or spouse. If your tax figures change you will need to do an Amendment. Prices Vary. If you have any federal or government debts (i.e. school loans, child support, DFCS, etc….) there is a chance that your refund will be applied towards your debt. You can call the offset department at 1-800-304-3107 or 1-800-829-7650 to see if your refund will be partially or fully taken. If your refund is fully taken you are responsible for paying the preparation fees. Broadway Tax Solutions LLC provides the taxpayer with ONE complimentary copy of their tax return. Should you need any additional copies, there is a $20 fee per copy (federal and state included). Broadway Tax Solutions LLC is not responsible for any discussions or changes the IRS or bank may make on disbursement dates, filing status or any other required information from the IRS. Broadway Tax Solutions LLC is not responsible for any IRS glitches or problems that may cause a delay in your tax refund. We DO NOT reimburse any bank fees in the event of this occurrence.

I/we declare that all information provided here is accurate and true by signing below. *

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Consent to Use Taxpayer Information

This form is provided to you by Broadway Tax Solutions LLC. Federal law requires this consent form be provided to you. Unless authorized by law, we cannot disclose your tax return information to third parties for purposes other than the preparation and filing of your tax return without your consent. If you consent to the disclosure of your tax return information, Federal law may not protect your tax return information from further use or distribution. 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 preparation services on your consent, your consent will not be valid. If you agree to the disclosure of your tax return information, 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. *

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Consent to Disclosure of Tax Return Information for Financial Products

This form is provided to you by Broadway Tax Solutions LLC. Federal law requires this consent form be provided to you. Unless authorized by law, we, as your Tax Preparer, 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. *

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Taxpayer Declaration and Signature Authorization

Under penalties of perjury, I declare that I have examined a copy of the income tax return (original or amended) I am now authorizing, and to the best of my knowledge and belief, it is true, correct, and complete. I further declare that the amounts in Part I above are the amounts from the income tax return (original or amended) I am now authorizing. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send my return to the IRS and to receive from the IRS an acknowledgement of receipt or reason for rejection of the transmission, the reason for any delay in processing the return or refund, and the date of any refund. If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of my federal taxes owed on this return and/or a payment of estimated tax, and the financial institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a payment, I must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be received no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I further acknowledge that the personal identification number (PIN) below is my signature for the income tax return (original or amended) I am now authorizing and, if applicable, my Electronic Funds Withdrawal Consent. *

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DISCLOSURE AND CONSENT TO RECEIVE DOCUMENTS ELECTRONICALLY
With your consent, Republic Bank & Trust Company (“Republic”) will deliver the Refund Transfer Application and Agreement (the “Agreement”) and all related disclosures and notices (collectively referred to as “Bank Documents”) to you by displaying or delivering them electronically, and requesting that you print or download and retain the Bank Documents for your records. If you are filing a joint tax return, the pronouns “you” and “your” used in this shall be understood to include both you and your spouse, where applicable.

DISCLOSURE AND CONSENT TO RECEIVE DOCUMENTS ELECTRONICALLY
This Disclosure contains important information that you are entitled to receive before you consent to electronic delivery of the Bank Documents. Your consent also permits the use of electronic signatures and electronic records in connection with the Agreement. Please print or download a copy this Disclosure for your files.

After you have read this Disclosure, if you agree to receive the Bank Documents from Republic electronically, and if you agree to the general use of electronic records and electronic signatures with Republic, please sign below.

Computer Hardware/Software Requirements
In order to access your Bank Documents electronically, you must: 1. Be able to view the Bank Documents on your monitor. 2. Have access to an internet service provider and use Internet Explorer 11.0 and higher, Firefox 51.0 and higher, Google Chrome 56 and higher, Safari 7 and higher, or Edge 20 and higher to receive required information. 3. Be able to print (recommended) or download the Bank Documents.

Your Consent is Required
Please be advised that if you do not consent to electronic delivery of the Bank Documents, Republic cannot proceed with the acceptance and processing of your Agreement. Your consent does not require Republic to provide the Bank Documents electronically. Republic, at its discretion, may deliver the Bank Documents or otherwise communicate with you through other means. Furthermore, Republic may require certain communications from you to be delivered to Republic, on paper, at a specified address.

Withdrawal of Consent
If you consent to electronic delivery of the Bank Documents, you may withdraw that consent at any time. To withdraw consent after clicking below, please contact Republic’s Tax Refund Solutions’ Taxpayer Support at 1-866-581-1040.

Paper Copies Available
At any time, you may request to receive paper copies of the Bank Documents by mailing Republic’s Tax Refund Solutions ATTN: Exception Processing, PO Box 2348, Louisville, KY 40201. Postage fees may apply.

Consent
Please read the below paragraph and if you consent to the terms, sign below.

I confirm that the Internet access device I will use to receive the Bank Documents meets the requirements described above and that I have been able to view this Disclosure using that Internet access device. I have read the Disclosure and consent to receiving the Bank Documents electronically and also consent to the use of electronic signatures in place of handwritten signatures and the use of electronic records in connection with the Bank Documents *

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The information contained in this office or on this website is of a general nature. It should not be construed as legal advice nor should it be acted upon in your specific situation without further details and/or professional assistance. Any use of information contained in this office or on our web site is done so at the risk of the user, and Broadway Tax Solutions LLC is not responsible for the result or outcome of its use. Broadway Tax Solutions LLC does not guarantee and is not liable for the truthfulness, accuracy, effectiveness, or any resulting effects of the use of any information contained in this office or on the web site. It is advised and it is the responsibility of the visitor of this office or web site to seek proper instruction and/or seek professional assistance in all matters regarding taxes and the IRS. Broadway Tax Solutions LLC is thus held harmless, released of, and users of information contained in this office or on this web site assume full responsibility for, any violation of Tax laws and/or IRS procedure, and any other legal liability resulting from use of any information contained in this office or on this web site. I attest that all information contained in this income tax return was obtained from the taxpayer or spouse and is true and correct to the best of his/her knowledge.
*

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If you need assistance, please book a virtual appointment at https://www.BroadwayTaxSolutions.com. We will be happy to help you! Thanks for choosing Broadway Tax Solutions LLC!

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Create a new account or sign in to an existing account to save and/or return to already saved work.