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

Please fill out as much as you can and send all documents requested to make the process much easier and faster.

Existing Business Client New Business Client

New Business Client

Referred Name*

Entity Type:

Sole Proprietorship LLC Partnership S-Corp C-Corp

English only Spanish Only Bilingual

First Name*

Middle Initial

Last Name*

Business Name*

EIN

Business Mailing Address

Suite / APT

City, State, Zip

Phone Number*

Other #

E-mail*

Circle "Yes" or "No":

Payroll + Contractors

Did you issue W-2s to any employee in 2025?

Yes No

Did you pay any independent contractors?

Yes No

Do you use a payroll provider?

Yes No

Home Office / Vehicle

Do you use part of your home exclusively for business?

Yes No

Do you use a personal vehicle for business?

Yes No

Existing Business Client

First Name*

Middle Initial

Last Name*

Business Name*

Phone Number*

E-mail*

Circle "Yes" or "No":

Payroll & Contractors (only if you have outside services from us)

Did you issue W-2s to employees?

Yes No

Did you pay independent contractors?

Yes No

Vehicle / Home Office (If applicable)

Do you use a vehicle for business?

Yes No

Do you claim a home office deduction?

Yes No

Tax Payments & Notices (that we don’t know of)

Did you make any 2025 estimated tax payments?

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 2027

Pursuant to Reg 301.7216-3, I (we), ____________________________________________ authorize RightWay Tax Solutions and Black Inc to use all information contained within my 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.

Black Inc (“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.