Client Intake | GHE Financial Group

TAX PROFESSIONAL FULL NAME

TAX PROFESSIONAL Email Address

FIRST NAME

MIDDLE INITIAL

LAST NAME

EMAIL ADDRESS

PHONE NUMBER

DATE OF BIRTH

SOCIAL SECURITY NUMBER

FULL ADDRESS

JOB ITITLE

PROTECTION PIN

FILING STATUS

LAST YEAR YOU WERE

As of December 31, 2020, were you or anyone in your household (Dependents) enrolled in a health plan through the Health Insurance Marketplace?If yes, click the box.

Let’s see if I prequalify for an advance up to $6000

HOW WOULD YOU LIKE YOUR REFUND?

Acceptance ConsentI/we, the taxpayer, have read the above information. I/we hereby consent to the disclosure of tax return information described in the GHE FINANCIAL TAX SERVICES. terms above and allow the tax return preparer to enter a PIN in the tax preparation software on my behalf to verify that I/we consent to the terms of this disclosure.

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Privacy Policy. The nature of our work requires us to collect certain nonpublic personal information about you from various sources. We collect financial and personal information from applications, worksheets, reporting statements, and other forms, as well as interviews and conversations with our clients and affiliates. We may also review banking and credit card information about our clients in the performance of receipt of payment. Under our policy, all information we obtain about you will be provided by you or obtained with your permission. Our firm has procedures and policies in place to protect your confidential information. We restrict access to your confidential information to those within our firm who need to know in order to provide you with services. We will not disclose your personal information to any third party without your express permission, except where required by law. We maintain physical, electronic, and procedural safeguards in compliance with federal regulations that protect your personal information from unauthorized access. Please contact us with any questions regarding our privacy policy.

CLIENT INTAKE FORM