FAX-A-TAX Intake Form

National Tax Centers Online Tax Information Filing System

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Intake
Part 1 - Personal Information
Part 2 - Marital Status and Household Information
Part 3 - Income
Part 4 - Expenses
Part 5 - Life Events
Part 6 - Healthcare Coverage
Part 7 - Additional Services

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By continuing, filling in this intake and authorizing by signing via digital selection, I understand to the best of my knowledge this information is true and accurate. I have all receipts, log books and all other documentation that is required to support my claim. If I am audited for any fault of my own, by giving false information, I will not hold National Tax Centers liable. I understand that I have the final responsibility for my income tax returns and therefore, I will review them carefully before I sign them or give electronic permission to proceed with processing my tax return to the federal and state agencies. I also understand that the I.R.S. does random audits and if chosen it is not because National Tax Centers has made an error on my return and that my refund will be held until I provide National Tax Centers with the information that is needed, additional fees may apply to represent you in the audit examination. I also understand that it could take up to 21 days to receive my tax refund if I filed electronically assuming that I don’t owe any other prior debts with any other government agencies including child support and student loans. If my entire refund is offset to pay any governmental agencies I do understand that I am still responsible for paying NTC for their services rendered. I also understand that if National Tax Centers enters my information into their system and afterwards I choose not to have my taxes filed with National Tax Centers I am subject to pay a cancellation fee of $50 before I receive my tax documents if my return has not been transmitted. I also give National Tax Centers permission to take their service fee out of my refund check and release any remaining refund to me. In the event that I do not have money to pay for services rendered, I give NTC permission to change my address to theirs so they can receive their service fee and I give them permission to endorse my name to the federal or state refund check. If I have provided my bank account information on my tax return and NTC could not collect their fees out of my refund check I am giving them full permission to deduct my bank account for the full balance owed. I also acknowledge that I received a copy of the Privacy Disclosure Act and the National Tax Centers warranty. If I filled this form out via Fax A Tax without physically being present at any NTC location, I give NTC permission to sign all of my financial information by using the signature on file relative to this form and or by using my electronic PIN that was used to electronically file my tax returns. If elected, I also give NTC permission to deduct the Audit Shied fee, HIV Foundation donation or any other additional services that may require deductions of fees.

Section 7216 Disclosure or Use of Information: Our communications are “confidential” not “privileged.” This means that in most cases our communications cannot be disclosed to third parties without your written consent. On the other hand, privileged communications are not permitted to be disclosed, even in court. If we are served by a properly issued administrative summons compelling us to testify in court proceedings, even our confidential communications are subject to disclosure.