jwellsandco

Tax Client Intake Form

What tax year is this submission for? (Please ensure that only documents for the selected tax year are attached. If you need multiple years filed, each year must be submitted as a separate request with its corresponding documents.) *

First Name

Last Name

Phone *

Email *

How did you hear about us? (If someone referred your please mention their name here)

Address

Street Address

City

State

Country

Postal Code

Birthdate:

Social Security Number:

Please select the filing status that you believe applies to your situation:

Please upload your Drivers License/ID for you and your spouse (if applicable)

Social Security Cards for each Individual you plan to list on your Tax Return *

If you are filing head of Houshold, what documents will you provide for proof of head of household?

Please upload proof of head of household, if applicable.

Do you have a spouse?

Yes

Spouse Full Name:

First Name
Last Name
Spouse Email
Spouse Phone Number
Spouse Occupation:

Are you disabled?

Yes

Are you diagnosed as disabled by a licensed Doctor?

Yes

Are you claiming dependents on this tax return?

Yes

Please explain your disability in detail here:

Dependent 1 Name, Dependent 1 Social Security #, Dependent 1 Date of Birth, Dependent 1 Relationship

Dependent 2 Name, Dependent 2 Social Security #, Dependent 2 Date of Birth, Dependent 2 Relationship:

Dependent 3 Name, Dependent 3 Social Security #, Dependent 3 Date of Birth, Dependent 3 Relationship:

Dependent 4 Name, Dependent 4 Social Security #, Dependent 4 Date of Birth, Dependent 4 Relationship:

Please upload proof of residency for each dependent:

Did you receive 1095A marketplace health insurance??

Yes

Upload 1095 A form here if applicable:

Upload 1095 A form here if applicable

Do you or your dependents have an IP PIN#?

Yes

List IPPIN# here if applicable and WHO it was issued to:

Were you audited by the IRS last year?

Yes

Do you have any credits that were disallowed or reduced?

Yes

If you have any credits that were disallowed or reduced, please enter here.

If you own your home, have you received form 1098 from your mortgage lender?

Yes

Please upload 1098 Mortgage Interest form if applicable:

Please answers only if it applies to you.

If your address is different than the one thats on your government ID or drivers license, please indicate the reason why

Federal Financial Documents

Please Select your Income type (Select Multiple if applicable)

Occupation Title:

Financial Tax Documents (W2,1099,Unemployment,ect)

If you received a 1099G form for unemployment, please upload it here.

Did you or your dependent attend College?

Yes

If you received a 1098T form for school, please upload here.

Do you need assistance with organizing your/side hustle business income & expenses?

Yes

Did you have a business in 2025? This includes any 1099 work or side businesses, such as hair braiding, hairstyling, babysitting, Uber, Lyft, DoorDash, etc. If so, what is the name and nature of your business or side hustle? If you don’t have a business name, you can skip that part.

Did you use your vehicle for business use?

Yes

If yes, please list the year make and model of the vehicle.

Other Documents

Do you want to apply for a cash advance of up to $7,000? No credit check is required. You will be notified of your approval within 24 hours, and funds will be deposited within 48 hours.

Yes

How would you like to receive your refund?

Direct Deposit

Printed Check

Prepaid Debit Card

If you selected direct deposit, please enter your information below

Bank Name:
Account Number:
Confirm Account Number:
Routing Number:
Confirm Routing Number:

Tax Form Abandonment/Ach Agreement

Here at JWells & Co. Unfulfilled Tax Quotes will result in a $150 Service Fee - If the client decides to file their tax return elsewhere. This fee will be processed through our payment merchant until fulfilled. If the client files their taxes with us, they will be charged the regular tax filing fees processed from the tax return per usual. No upfront fees - all fees will be cured from the tax return unless otherwise agreed due to intricate tax situations. Thank you - JWells & Co.

JWells & Company Business Consulting, LLC

Will prepare your 2025 individual tax return from the information you furnished to us. You, the taxpayer, are ultimately responsible for the preparation and filing of your tax return. I, the Taxpayer named above, have provided to JWells & Company Business Consulting, LLC the attached tax information and to the best of my knowledge this information is true, correct, and complete.

Security Questions *

Security Question Answer

CONSENT TO USE OF TAX RETURN

INFORMATION For the purposes of this consent form, “we,” “us,” and “our” mean

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 in 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. 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. If you do not consent, you may still have your tax return prepared and electronically filed by us for a fee.

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. If you would like us to use your tax return information to determine whether these products may be available to you while we are preparing your return, please sign and date this consent to the use of your tax return information.

By signing below, you authorize us to use the information you provide to us during the preparation of your 2025 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 e-mail at complaints@tigta.treas.gov.
CONSENT TO DISCLOSURE OF TAX RETURN INFORMATION

For the purposes of this consent form, “we,” “us,” and “our” mean .

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 in our tax preparation services. If we obtain your signature on this form by conditioning our 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.

You have indicated that you are interested in receiving an Electronic Disbursement Service and/or Loan (or collectively, “Products or Services”) from Pathward, National Association. In order to provide you with the opportunity to apply for one of these Products or Services, we must disclose all of your 2025 tax return information necessary for evaluating the request to Pathward.

If you request a more limited disclosure of tax return information, you will not be eligible to submit an application request for these Products or Services. If you would like us to disclose your 2025 tax return information for this purpose, please sign and date your consent to the disclosure of your tax return information.

By signing below, you authorize us to disclose to Pathward all of your 2025 tax return information necessary for the evaluation and processing of your request for a Product or Service. You understand that if you are unwilling to authorize the disclosure and sharing of your tax return information with Pathward, you will not be able to obtain a Product or Service, but you may still choose to have your tax return prepared and filed by us for a fee.

Letter of Engagement

Thank you for choosing Integrity First Tax and Financial Services to assist you with your income tax preparation needs. We are committed to providing accurate and reliable services, and to ensure clarity in our professional relationship, please review the following details.
Scope of Services
We will prepare your income tax returns based solely on the information you provide. Upon completing your tax returns, we will return any original documents to you. While our office may retain electronic copies of certain documents for record-keeping purposes, you are responsible for maintaining all original records, receipts, canceled checks, and other documentation that support your income, deductions, and tax positions.
These documents may include but are not limited to:
Records supporting deductions for meals, travel, business expenses, charitable contributions, and vehicle use (if applicable).
Bank and credit card statements or other financial records.
It is your responsibility to retain these documents for at least five years after the filing or due date of your tax returns, as they may be required in the event of an audit or review by tax authorities.
Limitations of Our Services
Our work in preparing your tax returns does not include the identification or detection of errors, irregularities, or illegal acts, including fraud. We will exercise professional judgment to resolve any tax law ambiguities in your favor where possible and reasonable. However, we cannot guarantee that the positions taken will not be challenged by taxing authorities, nor can we predict the outcome of such challenges.
Integrity First Tax and Financial Services cannot be held responsible for issues arising from incomplete or inaccurate information provided during the preparation process. It is critical that you disclose all income, expenses, and relevant details before filing.
Fees and Payment Terms
If you decide not to file your tax return after we have completed it, a fee of $150.00 will be charged for services rendered. This payment is due immediately.
In the event of nonpayment for services, Integrity First Tax and Financial Services reserves the right to pursue legal action to collect any outstanding balance. You may also be responsible for reimbursing our firm for legal or collection costs incurred.
Thank you again for entrusting Integrity First Tax and Financial Services with your tax preparation. We look forward to working with you and ensuring your financial success.

Tax Payer Signature ( Must be legible)

Clear

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Note:

2025 Tax Intake Form

Complete The Tax Client Intake Form Below. You must complete this form to apply for the up to $7,000 Cash Advance

WE APPRECIATE YOU FOR CHOOSING JWELLS & CO

Disclaimer

Thank you for choosing JWells & Co for your tax preparation needs! You had many options, but you entrusted us with your business, and we truly appreciate that.

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Speak With a JWells & Company Tax Specialist