INCOME TAXES VELOZ
INDIVIDUAL INCOME TAXES INTERVIEW FORM
NOTE: I certify that the above-mentioned/written information is true, expressed and accepted by me. It is the client’s obligation to keep their proof and documents for federal and state audits.
LONG FORM FOR INCOME TAXES
LIST OF EXPENSES THAT CAN BE DEDUCTED WITH W-2 AND/OR 1099
GENERAL AND EXPLANATORY NOTE: NOT ALL CLIENTS INCUR THE SAME EXPENSES NOR IN THE SAME AMOUNTS. EACH AMOUNT HAS BEEN EXPRESSED DURING AN INTERVIEW WITH THE CLIENT BY THE TAX PREPARER.
I ACCEPT THAT I HAVE READ AND CONFIRM THAT I ACCEPT WHAT IS IN THE LIST. I HAVE BEEN TOLD THAT I MUST KEEP MY PROOF/RECEIPTS CORRESPONDING TO IRS.
Tax Preparation Fee Acknowledgement
MetaBank®, National Association, has no ownership affiliation with your tax preparer or involvement in the tax preparation services you receive and fees incurred for preparing and filing electronically your federal and or state tax returns. Rather, MetaBank® offers tax refund-related products, including Refund Advance Loans and refund deposit accounts for qualified customers. You may incur set-up costs, transaction costs, and associated fees for services from MetaBank®, which will be separate from any fees relating to the preparation and electronic filing of your tax return.
MetaBank® will notify you of the costs, if any, for our tax refund-related products before you obtain them. Please note if you open a refund deposit account with us, then you will be directing the IRS and/or state taxing authority to issue your tax refund(s) electronically to this refund deposit account. Under the refund deposit account agreement, you direct MetaBank® to disburse tax refund proceeds in an amount sufficient to pay the tax preparation fees owed to your tax preparer. Therefore, the amount of your tax refund(s) will be reduced by the tax preparation fees owed to your tax preparer.
We have been advised by your tax preparer that your tax preparation fees exceed $400.00. Therefore, we ask that you verify the amount of the tax preparation fees owed to your tax preparer, which we will deduct from the refund deposit account and remit to your tax preparer.
By signing below, you acknowledge that you (i) have incurred the tax preparation fees set forth above; (ii) owe such fees to your tax preparer for the tax preparation services you received; and (iii) agree that such fees will [be] deducted from your tax refund(s) proceeds in the refund deposit account and remitted by MetaBank® to your tax preparer.
CONSENT TO DISCLOSURE OF TAX RETURN INFORMATION
For the purposes of this consent form, “we,” “us,” and “our” mean
(Printed Name of Tax Preparer)
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 Refund Advantage, a division of MetaBank, 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 2020 tax return information necessary for evaluating the request to Refund Advantage. 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 2020 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 Refund Advantage all of your 2020 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 Refund Advantage, 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.
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.
CERTIFICATIONS:
By signing this Application, you, the Primary Applicant (and Joint Applicant if applicable), hereby certify:
- The information you have provided is true and accurate.
- You are at least eighteen (18) years old (or older as required by applicable state law), and have presented to Tax Preparer one of the following valid forms of Picture ID: Driver’s License, BMV/DMV State ID, Military ID, Passport, Resident Alien ID, or other Government-Issued Picture ID.
- You understand that the Refund Disbursement Service is (i) an optional product offered in exchange for payment of a fee, (ii) not a loan or an extension of credit, (iii) not required in order to file your taxes or receive a Tax Refund.
- You received a completed copy of this Application and Agreement, and you have carefully read and considered all of the provisions of this Application and Agreement.
- You agree that the “Expected Refund Amount,” “Authorized Fees and Payments Disbursed from Refund,” “Estimated Total Deductions,” and “Estimate Refund Amount Paid to You” are good-faith estimates based upon the amount of your tax return filings.
- You authorize that we make each disbursement specified on the “Authorized Fees and Payments Disbursed from Refund” prior to disbursing the remaining proceeds to you.
- You have selected the disbursement option above to receive the remaining proceeds from your Tax Refund(s), if any.
- You have authorized your Tax Preparer to submit this Application on your behalf.
- You have read, understand, and agree to all of the terms of this Application and Agreement, including the ARBITRATION PROVISION AND JURY TRIAL WAIVER.
- You understand and agree to be bound by the terms of the Refund Disbursement Service Agreement.
USA PATRIOT ACT DISCLOSURE:
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT:
In an effort to protect you and our country, the USA PATRIOT Act was signed into law. To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens a new account. As such, we ask for your name, address, date of birth, and other information that will allow us to identify you. We may ask for a driver’s license or other identifying documents. We will share certain of this information with third parties as necessary to fulfill our obligations and as disclosed in this Application and Agreement.
For questions, complaints and concerns, call toll free at (888) 782-0860.
Applicable your spouse, have delinquent child support or outstanding unpaid taxes, student loans, or other federal debt or a review of information contained in your credit report(s) or an inability to verify your identity. We will notify you of our decision in writing.
Military Lending Act. The Military Lending Act provides protections for certain members of the Armed Forces and their dependents (“Covered Borrowers”). The provisions of this section apply to Covered Borrowers as defined by 32 C.F.R. § 232.3(g).
Statement of MAPR: Federal law provides important protections to members of the Armed Forces and their dependents relating to extensions of consumer credit. In general, the cost of consumer credit to a member of the Armed Forces and his or her dependent may not exceed an annual percentage rate of 36 percent. This rate must include, as applicable to the credit transaction or account: The costs associated with credit insurance premiums; fees for ancillary products sold in connection with the credit transaction; any application fee charged (other than certain application fees for specified credit transactions or accounts); and any participation fee charged (other than certain participation fees for a credit card account).
Oral Disclosures: To hear a statement of the MAPR and a clear description of your payment obligation, please call 844-549-7937.
Covered Borrower Savings Clause: If any contract provision not identified herein is contrary to the rights and protections afforded to Borrower by Federal law pursuant to 10 U.S.C. § 987 and its implementing regulations, including, but not limited to 32 C.F.R. § 232.8, then the conflicting provisions or proscribed terms are inoperative, and shall have no force and effect. However, all remaining contract terms and provisions not proscribed or prohibited shall remain in full force and effect.
NOTE: If a joint tax return is being filed, the Joint Filer must sign the Spouse Agreement and Joint Filer Authorization for Release of Information on the following pages.
DO NOT SIGN THIS REFUND ADVANCE LOAN APPLICATION AND LOAN AGREEMENT UNTIL YOU READ ALL OF THE TERMS. REVIEW EACH OF THE FREQUENTLY ASKED QUESTIONS ABOVE. CALL (888) 728-0860 IF YOU STILL HAVE QUESTIONS ABOUT THIS LOAN. THE MONEY YOU RECEIVE FROM A REFUND ADVANCE LOAN IS NOT YOUR TAX REFUND. YOU FURTHER ACKNOWLEDGE THAT RECEIVING A LOAN FROM US DOES NOT ACCELERATE THE TIMING FOR RECEIVING YOUR TAX REFUND. THAT IS, YOU WILL NOT RECEIVE YOUR TAX REFUND “FASTER” OR “QUICKER” BY OBTAINING A LOAN FROM US. IF YOUR APPLICATION IS DENIED, YOU WILL STILL RECEIVE YOUR TAX REFUND IN THE MANNER YOU CHOSE DURING TAX PREPARATION. NOTE THAT ANY FEES YOU PAID TO YOUR TAX PREPARER FOR YOUR TAX PREPARATION WILL NOT BE REFUNDED.
Authorization for Release of Information
This document authorizes MetaBank, National Association, and its service providers to contact the U.S. Department of the Treasury, Bureau of the Fiscal Service, Treasury Offset Program Call Center on the applicant’s behalf regarding the review of their loan application. The form permits the use and disclosure of the information provided in the application to the Department of the Treasury, Bureau of the Fiscal Service, and obtain any information related to debt owed by the applicant or co-applicant to the United States Government, a State, or any debt enforced by a State, including child support obligations and/or payments owed to a federal or state agency. The authorization is valid for six months from the date of signature unless revoked in writing.
LIMITED PURPOSE MARRIED JOINT TAX FILER AGREEMENT
For purposes of this LIMITED PURPOSE MARRIED JOINT TAX FILER AGREEMENT (“SPOUSE AGREEMENT”), the words “we”, “us” and “our” mean MetaBank®, National Association. The words “you” and “your” mean the spouse of the tax preparation customer applying for the Refund Advance Loan and signing above. Please review this SPOUSE AGREEMENT and sign and complete the information requested on the lines below if your filing status is married filing jointly and your spouse is applying for the Refund Advance Loan (a “Joint Filer”). By signing below, you acknowledge and agree that:
You are not applying for the Refund Advance Loan;
You are not agreeing to be, and will not be held, personally liable for the Refund Advance Loan received by your spouse;
If your spouse’s application is approved, then any Tax Refund from your jointly filed income tax return(s) may be used to repay the Refund Advance Loan;
You grant us a security interest in any 2020 federal and, if applicable and permitted by state law, state Tax Refund(s) from your jointly filed tax return to repay the Refund Advance Loan received by your spouse;
You agree that you have received a copy of our Privacy Policy;
The Arbitration Provision and Jury Trial Waiver set forth above is incorporated herein by reference and governs disputes or claims against us relating to this SPOUSE AGREEMENT.
Joint Filer Authorization for Release of Information
By signing below, you authorize MetaBank, National Association, and its service providers to contact the US Department of Treasury, Bureau of the Fiscal Service Treasury Offset Program call center on your behalf in connection with our review of your spouse’s application for a Refund Advance Loan, and to use and disclose the information provided in your spouse’s application to the US Department of Treasury, Bureau of the Fiscal Service, and to obtain any and all information related to debt owed by you to the United States Government, to a State, or any debt enforced by a State, including child support obligations and/or any payments made or due to you by a Federal or State agency, and/or any tax return information disclosed to the Internal Revenue Service in order to collect tax debt through the levy process under 26 U.S.C. §6331(h), and to conduct tax refund offset under 26 U.S.C. §6402. Tax return information is defined in 26 U.S.C. §6103(b). Information includes, but is not limited to, correspondence and other information related to your debt(s) or payment(s), including your tax refund payment(s). You authorize the U.S. Department of the Treasury, Bureau of the Fiscal Service to disclose the information described above to MetaBank, National Association and its service providers. This authorization extends to any automated system or by any other written, electronic or telephonic means. You agree to complete and sign all documents necessary to obtain such information from the US Department of Treasury, Bureau of the Fiscal Service Treasury Offset Program. You understand that the US Department of the Treasury, Bureau of the Fiscal Service, its employees, agents, and contractors, are not required to inform you of disclosures made under this authorization. This authorization authorizes the use and disclosure of information described above from any tax year. This authorization will be valid for 6 months from the date of signing, unless sooner revoked by you in writing and the revocation is received and processed by the US Department of Treasury, Bureau of Fiscal Service at this address: Supervisor, TOP Call Center, P.O. Box 1686, Birmingham, Alabama 35201-1686.
CUSTOMER SERVICE: 800-901-6663
Collection Authorization in Section 8 above, if applicable, the automatic debiting of your Account set forth in Section 5 above by Servicer to cover tax preparation, document preparation and electronic filing fees in the event your federal and state refund proceeds are not sufficient or if your refund proceeds are delayed, and the Arbitration Provision in Section 12 above which may substantially limit your rights in the event of a dispute.
Taxpayer/Applicant Date
Taxpayer/Applicant (if filing jointly) Date
2025 RT Application and Agreement_ProSeries, 2025-28, January 2025
IRS E-FILE SIGNATURE AUTHORIZATION
Part I Tax return information – Tax year ending december 31
Enter whole dollars only on lines 1 through 5.
Nota: Form 1040-SS filers use line 4 only. Leave lines 1, 2, 3, and 5 blank.
Part II Taxpayer declaration and signature authorization (Be sure you get and keep a copy of your return)
Under penalties of perjury, I declare that I have examined a copy of the income tax return (original or amended) I am now authorizing, and to the best of my knowledge and belief, it is true, correct, and complete. I further declare that the amounts in Part I above are the amounts from the income tax return (original or amended) I am now authorizing.
I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send my return to the IRS and to receive from the IRS (a) an acknowledgment of receipt or reason for rejection of the transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund.
If applicable, I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct debit) entry to the financial institution account indicated in the tax preparation software for payment of my federal taxes owed on this return and/or a payment of estimated tax, and the financial institution to debit the entry to this account. This authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke (cancel) a payment, my ERO must contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be received no later than two business days prior to the payment (settlement) date.
I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I further authorize the financial institution to provide my intermediate service provider and/or transmitter with information about the payment (such as date of payment, whether the payment was successfully processed, and reasons for any payment rejection). If I have filed a joint return, this is an irrevocable appointment of the other spouse as an agent to receive the information and to answer inquiries regarding the payment.
To revoke (cancel) a payment, contact the U.S. Treasury Financial Agent at 1-888-353-4537. Payment cancellation requests must be received no later than two business days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I further authorize the financial institution to provide my intermediate service provider and/or transmitter with information about the payment (such as date of payment, whether the payment was successfully processed, and reasons for any payment rejection). If I have filed a joint return, this is an irrevocable appointment of the other spouse as an agent to receive the information and to answer inquiries regarding the payment. I further acknowledge that the personal identification number (PIN) below is my signature for the income tax return (original or amended) i am now authorizing and, if applicable, my Electronic Funds Withdrawal Consent.
Taxpayer’s PIN: check one box only
I authorize to enter or generate my PIN as my signature ono the income tax return (Original or amended) i am now authorizing.
I will enter my PIN as my signature on the income tax return(original or armended) I am authorizing. Check this box only if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
Spouse’s PIN: check one box only
I authorize to enter or generate my PIN as my signature ono the income tax return (Original or amended) i am now authorizing.
I will enter my PIN as my signature on the income tax return(original or armended) I am authorizing. Check this box only if you are entering your own PIN and your return is filed using the Practitioner PIN method. The ERO must complete Part III below.
PRACTITIONER PIN METHOD RETURNS ONLY - continue below
Part III Certification and Authentication – Practitioner PIN method only
ERO’s EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self select PIN.
I certify that the above numeric entry is my PIN, which is my signature for the electronic individual income tax return (original or amended) I am now authorized to file for tax year indicated above for the taxpayer(s) indicated above. I confirm that I am submitting this return in accordance with the requirements of the Practitioner PIN method and Pub. 1345, Handbook for Authorized IRS e-file Providers of Individual Income Tax Returns.
ERO Must Retain This Form — See Instructions Don’t Submit This Form to the IRS Unless Requested To Do So
REFUND TRANSFER FEE DISCLOSURE
In this Refund Transfer (“RT”) fee disclosure form, the term “you”, “your” and “yours” refers to each “Taxpayer” signing below. The words “we”, “us” and “our” refer to Santa Barbara Tax Products Group, LLC, a division of Green Dot Corporation, a Delaware corporation (“Servicer”) and Green Dot Bank (“Bank”). In accordance with your instructions in the Refund Transfer Application and Agreement (“Agreement”), upon receipt of your tax refund from the Internal Revenue Service (“IRS”), Servicer will pay out your refund as indicated below:
If you apply for and receive one or more tax refund advances from a third party refund advance provider in 2025, the above amount paid directly to you will be reduced by the amount of such refund advances on those refund advances.
¹ This Refund Transfer Fee Disclosure reflects the estimated amount paid directly to you using the expected federal refund amount and does not take into account any amount due to you from any state taxing authorities, as that amount is typically not estimable at this time. In the event any of your state tax refunds are disbursed to Bank before the federal tax refund, the above fees will be deducted from that state refund first, and any balance from subsequent refunds received. See the Subsequent Refunds section below for more details.
² The RT Processing fee will be retained by Servicer for its refund transfer processing services and may be shared with the transmitter of your return to the IRS (“Transmitter”). Servicer shall pay Bank for its banking services. The RT Processing Fee will be increased by $14.95 if Servicer processes federal and state refunds for you (an additional $14.95 fee will be incurred for each state thereafter if multiple state returns are processed).
³ The amount paid directly to you may be less if the IRS does not send us your full refund. If the amount actually paid to you is less than the amount shown above, you can view an updated itemization on our website by logging on to As discussed in Footnote 1, the amount shown here does not reflect state tax refund amounts, if any.
Subsequent Refunds: Although you may be filing for and receive tax refunds from both the IRS and one or more state tax authorities, the itemization above only reflects your expected federal tax refund amount, as any refund due from a state taxing authority is typically not estimable at this time. We will deduct the RT Processing Fee and the fees indicated above from the first tax refund the Bank receives, whether that be federal or state, and any balance that remains unpaid will be deducted from any subsequent refunds in the order they are received before disbursing any balance of the refund proceeds to you. Note that we will deduct the additional $14.95 RT Processing Fee at the time the Bank receives any subsequent refund.
29j – 2025 RT Fee Disclosure_ProSeries – 005
REV 12/13/24 PRO
ADDITIONAL DISCLOSURES: Once your Agreement has been signed and transmitted to Servicer, and Servicer has received an acknowledgement that your electronically filed tax return has been received and accepted by the IRS, a bank account at Bank, which will remain open for six (6) months (or longer, at Bank’s sole discretion) (the “Account”) will be opened in your name at Bank for the purpose of receiving a direct deposit of your tax refund from the IRS or state tax authority. If and when the tax refund has been deposited by the IRS or state tax authority to your Account, Servicer will make all deductions in the manner indicated above and disburse the balance of the Account to you in accordance with the disbursement method chosen by you in the Agreement. Servicer and Bank have no control over and cannot guarantee if or when the IRS or state tax authority will issue you a refund or what the amount of your expected tax refund will be. In the event your 2024 federal and/or state refunds are not sufficient to cover the fees or other amounts due for products or services set forth in the Agreement, including repayment of and interest associated with refund advance products (“Outstanding Amounts”), any Outstanding Amounts may be deducted from refunds that you may receive up to 36 months after the date of the Agreement and process through the Servicer.
If you select the direct deposit disbursement method, you authorize Servicer to electronically debit your Authorized Destination Account for tax preparation, document preparation and electronic filing fees (“Tax Prep Fees”) in the event i) your Tax Prep Fees are not fully paid from your federal and/or state refunds for any reason or if we consider, in our sole discretion, your refund proceeds delayed based on applicable tax deadlines set by the IRS, and ii) your tax preparer has not opted out of the Auto-Collect Program (as defined in the Agreement) or has not opted you, specifically, out of the Auto-Collect Program. For more details on the Auto-Collect Program and instructions to opt out, please refer to section 5 of the Agreement. Note that any Outstanding Amounts not collected pursuant to the Auto-Collect Program may still be recovered pursuant to the “Additional Disclosures” section above.
BY SIGNING BELOW, you acknowledge that you have received this Refund Transfer Fee Disclosure and agree to have your tax refunds disbursed as indicated above.