Interview Sheet

Address: 742 S Atlantic Boulevard,
Los Angeles, CA 90022

Contact Information
Phone: (323) 263-3399
Text: (323) 275-1099
Fax: (323) 210-7020
Email: info@blackinctax.com
Our new email is info@blackinctax.com (We'll still receive emails from info@ataxcompany.com)

Preferred Language

Returning Client New Client

Personal Information

Single Married Filing Jointly Married Filing Separate Head of Household Widower

First Name*

Middle Name

Last Name*

SSN

D.O.B*

Occupation*

Mailing Address*

APT

City, State, Zip*

Cell #*

Other #

E-mail*

Prior Year Refund

Federal*

State*

How do you want to receive your refund?

Direct Deposit Check at our Office Check to your Home

Dependents

How many dependents are you including in this return?

Circle "Yes" or "No":

Did you receive alimony? (Only if divorced pre-2019)

Yes No

Did you operate a business, side hustle, or gig work in 2025?

Yes No

Did you receive any income or own property from overseas?

Yes No

Deductions & Expenses

Did you make any charitable donations (cash or items)?

Yes No

Did you pay out-of-pocket medical or dental expenses over $1,000?

Yes No

Do you own a home?

Yes No

IRS Communication & Tax History

Did you receive any IRS letters or notices in 2025?

Yes No

Did you have any audits or reviews opened by the IRS or State?

Yes No

Are you currently under an installment agreement or payment plan?

Yes No

Did you file or plan to file an amended return for a prior year?

Yes No

Did you have any prior year tax debts paid, settled, or forgiven?

Yes No

In 2025, did you get a loan for a car assembled in the U.S.?

Yes No

Attach Documents

Drop files here to upload or choose file

PDF, images, Excel, Word

CONSENT TO USE

Taxpayers Initials

Federal law requires this consent form be provided to you (“you” refers to each taxpayer, if more than one). Unless authorized by law, we cannot use, without your consent, your tax return information for purposes other than the preparation and filing of your tax return. If you consent to the use of your tax return information, Federal law may not protect your tax return information from further use or distribution.

If we obtain your signature on this form by conditioning our services on your consent, your consent will 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 then your consent is valid for one year from the date of signature.

Duration of consent: Calendar year 2024 through Calendar year 2026

Pursuant to Reg 301.7216-3, I (we), ____________________________________________ authorize RightWay Tax Solutions and Atlantic Tax Services to use all information contained within my 2024 tax return to determine whether to offer me a bank product from Refund Advantage.

Pursuant to Reg 301.7216-3, I (we), ____________________________________________ authorize RightWay Tax Solutions, Inc. and Atlantic Tax Services to use any and all tax return information. Including all forms, schedules, documents and attachments for the purpose of offering a prepaid tax audit assistance, support and representation service, provided by Audit Protection.

Atlantic Tax Services (“we,” “us” and “our”)

For your convenience, we have entered into an arrangement with certain companies to offer an Electronic Refund Disbursement Service and/or Loan product. To determine whether these offerings may be of interest to you, we will need to use your tax return information. If you would like us to use your tax return information to determine whether these offerings are relevant 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 2024 tax return to determine whether to offer you an opportunity to apply for the Electronic Refund Disbursement Service and/Loan product.

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 email a complaints@tigta.treas.gov.

CONSENT TO TEXT AND AUDIT DISCLOSURE

Taxpayers Initials

We will be sending you text messages of our company updates, reminders, upcoming events, deadlines and greetings. By printing your initials below, you authorize us to send you text messages from our company.

Personal Information

Spouse Information

Prior Year Refund

How do you want to receive your refund?

Dependents

Circle "Yes" or "No":

Attach Documents

CONSENT TO USE

CONSENT TO TEXT AND AUDIT DISCLOSURE