INTAKE FORM

Please be advised that if there's any years prior to the current year filing which is 2025 there's an upfront review fee for $100 for past years taxes that's not refundable due upfront with submission however if you file your taxes with us you will get a credit for that amount towards your final payment!

FILING STATUS

DEPENDENT INFORMATION (If Applicable)

Dependent #1

Full Name: ____________________________

Relationship: _________________________

Date of Birth: ____ / ____ / ______

SSN: ___ ___ ___ – ___ ___ – ___ ___ ___ ___

Lived with you more than half the year? 

☐ Yes ☐ No

Dependent #2

Full Name: ____________________________

Relationship: _________________________

Date of Birth: ____ / ____ / ______

SSN: ___ ___ ___ – ___ ___ – ___ ___ ___ ___

Lived with you more than half the year? ☐ Yes ☐ No

Dependent #3

Full Name: ____________________________

Relationship: _________________________

Date of Birth: ____ / ____ / ______

SSN: ___ ___ ___ – ___ ___ – ___ ___ ___ ___

Lived with you more than half the year? ☐ Yes ☐ No

(Attach additional page if needed)

REFUND DIRECT DEPOSIT (OPTIONAL)

Bank Name: ____________________________

Routing Number: _______________________

Account Number: ______________________

☐ Checking ☐ Savings

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CLIENT AUTHORIZATION & CERTIFICATION

I certify that all information provided is true, correct, and complete to the best of my knowledge. I authorize Credit Reset Pros to prepare and electronically file my tax return once I review and approve the final numbers.

Prepared By: Latasha Taylor

Credit Reset Pros