Form

status
Get Started: Personal Information

To complete your Refund Anticipation Loan let's find out more about you.
Primary Taxpayer *

First Name Last Name Middle Initial
SSN *
Date of Birth *

Month Day Year
Filing Status *

Single Married Filing Jointly Married Filing Separately Head of Household Widowed

Home Address (PO Box not valid)
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone number *

- Area Code Phone Number
E-mail *
Valid Identification *

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Example: Driver's License Cancel of
Take a Selfie *

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Photo of loan applicant MUST MATCH Cancel of

Spouse *

First Name Last Name Middle Initial
Spouse's SSN *
Spouse's Date of Birth *

Month Day Year
Spouse Identification *

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Spouse must provide Photo ID Cancel of
Spouse Social Security Card *

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Spouse must provide SSN Card Cancel of
Spouse E-mail Address *
How many dependents are you claiming? *
Can anyone else claim any of your dependents? *

Yes No I am not sure
Do you have the minimum required health insurance for you and all dependents? *

Dependent Care Expense

To calculate the Dependent [Child] Care Expense Credit tell us more details:
Name of Care Provider *
Address of provider or location of care provided *
Address should include zip code
Amount paid out of pocket *
Provider identification number - 9 digit EIN *
Enter 99-9999999 for tax-exempt organization

Get Started: Income

To determine your earned taxable income you may need to provide your:

·        W-2s or Paycheck Stubs [Shows total income YTD for tax year]

·        W-2Gs, records of gambling winnings and losses

·        Forms 1099-G or Unemployment statement
Employers you/spouse had (combined) during 2018? *

Earned Income

To determine your taxable income tell us details about your wage income:

Employer #1 -Start
Employer *
Employer Tax ID *

2018 W-2 Form Tax Calculations *

	W-2 Wage Amounts
1 Wages, Tips, other compensation
2 Federal income tax withheld
16 State wages, tips etc.
12 Retirement Plan
19 Local Income tax

Proof of income *

Browse or Take Photo
Final Paystub of December 2018 Cancel of

Employer #1 -End

Employer #2 -Start
Employer #2 *
Employer #2 Tax ID *

2018 W-2 Form Tax Calculations *

	W-2 Wage Amounts
1 Wages, Tips, other compensation
2 Federal income tax withheld
16 State wages, tips etc.
12 Retirement Plan
19 Local Income tax

Proof of Income Employer #2 *

Browse or Take Photo
Final Paystub of December 2018 Cancel of

Employer #2 -End

Employer #3 -Start
Name of Employer #3 *
Employer #3 Tax ID *

2018 W-2 Form Tax Calculations *

	W-2 Wage Amounts
1 Wages, Tips, other compensation
2 Federal income tax withheld
16 State wages, tips etc.
12 Retirement Plan
19 Local Income tax

Proof of income Employer #3 *

Browse or Take Photo
Final Paystub of December 2018 Cancel of

Employer #3 -End

Employer #4 -Start
Name of Employer #4 *
Employer #4 Tax ID *

2018 W-2 Form Tax Calculations *

	W-2 Wage Amounts
1 Wages, Tips, other compensation
2 Federal income tax withheld
16 State wages, tips etc.
12 Retirement Plan
19 Local Income tax

Proof of Income Employer #4 *

Browse or Take Photo
Final Paystub of December 2018 Cancel of

Employer #4 -End

Tax Return -Start
Have you ever filed your taxes with Taxnet Financial? *

Yes No

{primaryTaxpayer}

Taxnet Financial Inc. has been offering tax preparation services and tax-related products responsibly for over 15 years.

Taxnet Financial Better Business Bureau Review

Our goal is to exceed your expectations. Our core principles include:
1. The accuracy of a tax return. We fix any error on a previously filed tax return free of charge regardless of fault.
2. The security of personal information. We do not share any data with third parties without written consent.
3. Customer service available year round for your benefit.
4. Reasonable fee. We base our fee on the national average and we do not charge for additional services.
5. Communication and full dislosure so that you know exactly what is happening with your tax refund and "RAL" (if applicable).
We know you have many choices for tax preparation so we appreciate the opportunity to serve you.

Janice Cave,

Compliance Officer
Social Security Card *

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Primary Taxpayer Social Security Cancel of
Prior Year Tax Documents

Browse or Take Photo
Example: 2016 tax return Cancel of
To ensure we don't miss any deductions upload your prior year tax return and other tax documents that may assist us in the preparation of your "RAL" application and tax return.

As a new client we are also required to obtiain a copy of your Social Security Card.

Please feel free to contact us if you have any questions:

Taxnet Financial Inc.

312-698-3651

refund@taxnetfinancial.com

Available Monday-Friday 9am to 5pm CST

Tax Return-End

Self Employment -Start
Earned Income

To determine your taxable income tell us details about any self-employment income:
Did you or your (spouse) earn any self-employment income?
Occupation *
Total Income
Business Expenses
Meals and Enteratinment
Business Miles
Enter Miles Driven
Proof of Business (e.g. 1099, Bank Deposits, Expense Receipts) *

Browse Files
Self Employment Income will not be considered for a RAL without robust documentation. Cancel of

Self Employment -End
A Refund Anticipation Loan "RAL" is a loan advance and is NOT your actual refund. There is no finance charge for a "RAL" because the loan advance is secured by your actual refund. You do not have to apply for a "RAL" in order to e-file your taxes. The IRS has free options available for taxpayers. For more information please visit www.irs.gov

In order to apply for a "RAL" you MUST agree tp e-file your taxes with Taxnet Financial Inc. for a fee. Tax preparation fees include:
1. Federal Tax Preparation
2. State Tax Filing (up to 4 states)
3. Preparation of RAL Applications
4. Audit Assistance
5. Filing Corrections Regardless of Fault
6. Free Copies
7. Free Tax Preparation for Dependents
8. Tax Planning Assistance
9. Year Round Customer Service
If you do not intend on filing your taxes with Taxnet Financial Inc. for a fee do not continue this application. Tax preparation fees apply regardless of "RAL" decision. If you have a delinquent state or federal agency debt you may not be approved for a "RAL".

All loan funds are loaded on a prepaid card and shipped priority via FedEx [signature of applicant required at time of delivery/pick-up].

Holiday Loan Advance is $300

Refund Anticipation Loan is $1,500

Taxnet Financial Inc. reserves the right to reject a tax refund anticipation loan application except for on the basis of race, color, religion, national origin, sex, marital status, or age (provided the applicant has the capacity to contract); to the fact that all or part of the applicant’s income derives from a public assistance program; or to the fact that the applicant has in good faith exercised any right under the Consumer Credit Protection Act. Please be responsible and consider all refund options prior to applying for a tax refund anticipation loan advance.
I have read the consumer alert. I am interested in applying for both the $300 holiday advance and the $1,500 refund anticipation loan. I understand that I must e-file my taxes to apply for a tax loan and my tax return will be e-filed by Taxnet Financial Inc. regardless of the third-party refund anticipation loan decision.

Agree to the terms and conditions

Other Income

To determine your taxable income tell us details about your other income:
Check all that apply:

Withdrawal from a retirment fund Received interest income Received a state tax refund Received other misc. income Received gambling winnings Collected unemployment benefits

Retirement Fund Start
Withdrawal or Rollover of Retirement Fund

To determine your taxable income tell us details about your retirment fund withdrawal:
Retirement withdrawal *
1099R or statement

Browse or Take Photo

Cancel of
Did you rollover the withdrawal amount to another individual retirement account "IRA"?

Retirement Fund End

Interest or Dividend Income Start
Interest or Dividend Income

To determine your taxable income tell us details about your retirment fund withdrawal:
Interest and dividend income earned *

Interest or Dividend Income End

State or Local Refund Start
State or Local Tax Refund

To determine your taxable income tell us details about your state or local tax refund:
2017 State or Local tax refund received in 2018

State or Local Refund End

Misc Income Start
Miscellaneous Income

To determine your taxable income tell us details about your miscellaneous income:
Type of miscellaneous income
Amount of miscellaneous income

Misc Income End

Gambling Winnings Start
Gambling Winnings

To determine your taxable income tell us details about your gambling winnings:
Winnings during 2018
Losses during 2018
W-2G or winnings statement

Browse or Take Photo

Cancel of

Gambling Winnings End

Unemployment Start
Unemployment Benefits

To determine your taxable income tell us details about your unemployment benefits:
Benefits received
Federal Withholding
1099G or statement

Browse or Take Photo

Cancel of

Unemployment End
Adjustments and Credits

Almost finished let's find out if you are eligible for any adjustments or credits:
Check all that apply:

Paid homeowner expenses Paid moving expenses Paid employee business expenses Paid medical, dental, or vision Contributed to a charity Paid tuition expenses

Homeowner -Start
Homeowner Expenses

To determine your itemized deductions provide us with more details about your homeowner expenses.
Mortgage Interest *
Enter $0 if not paid
Real Estate Taxes *
Enter $0 if not paid
Property Identification Number
Required to claim real estate taxes credit in some states.

Homeowner -End

Moving Expense- Start
Moving Expenses

To determine the adjustment to your gross income provide details about your moving expenses.
Moving expense of personal items

Previous Residence

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Hotel expense
Miles Driven

Moving Expense- End

Employee Expense- Start
Employee Business Expenses

To determine your itemized deductions provide us with more details about your employee business expenses.
Travel Expenses
Parking and Tolls
Meals and Entertainment
Business Mileage

Moving Expense- End

Medical Expense-Start
Medical, Dental, and Vision Expenses

To determine if you qualify for the American Opportunity Credit please provide us with more details about your tuition expenses.
Medical Expenses
Insurance Premiums Paid

Medical Expense-End

Charitable Contributions - Start
Charitable Contributions

To determine your itemized deductions provide us with more details about your charitable contributions.
Cash contributions
Non-cash contributions

Charitable Contributions - End

Tuition Expense-Start
Tuition Expenses

To determine if you qualify for the American Opportunity Credit please provide us with more details about your tuition expenses.
Name of Student

Tuition expenses
Did the student receive a 1098T form last year? *
Enter EIN from Form 1098T *
1098T or tuition statement

Browse or Take Photo

Cancel of
Name of Student #2

Tuition expenses
Student #2
Did student #2 receive a 1098T form last year? *
Enter EIN from Form 1098T *
1098T or tuition statement

Browse or Take Photo

Cancel of

Tuition Expense-End
Direct Deposit
Name of Financial Institution *
Account Type *

Checking Savings Prepaid Card
Routing Number *
Account Number *
DO NOT SUBMIT THIS APPLICATION IF THE ROUTING TRANSIT OR ACCOUNT NUMBER LISTED ABOVE IS INCORRECT,CLOSED, OR FOR ANY REASON YOUR FINANCIAL INSTITUTION WILL NOT ACCEPT AN ACH FEDERAL AND/OR STATE REFUND.

There are no upfront fees charged to your account. All fees are deducted from your actual tax refund(s).

Do you agree to e-file YOUR tax return with Taxnet Financial regardless of RAL decision? *

Yes
Have you filed your tax return with another company? *
Warning: DO NOT SUBMIT THIS APPLICATION if you have already filed your tax return. Duplicating e-filings with IRS cause significant delays in processing your actual refund. Your RAL application will also be rejected.
Has the IRS assigned you an Identity Protection PIN? *
Provide your six digit Identity Protection PIN (If you have been a victim of identity theft and received a CP01A letter from the IRS)
PIN must match IRS records prior to RAL approval

Refund Anticipation Loan Disclosure

1. Refund Anticipation Loan ("RAL") Fee Schedule:

RAL Funding Amount (Requires Approval)    $1,200.00

Finance Charges *(0.00)

Tax Preparation Fees    **(450.00)

Proceeds Paid Directly to You $750.00

2. Total Finance Fee of the "RAL": $0.00* (APR 0%) There are no finance charges or late fees since your loan is secured by your actual refund.

3. Tax Preparation Fee for administrating, preparing, and filing YOUR Federal and State tax return is $450.00**. Tax Preparation Fees apply regardless of "RAL" decision.

4. Upon "RAL" Approval, a $250 Holiday Advance is disbursed immediately and the remaning $500 "RAL" proceeds are disbursed within 12 hours after IRS acceptance of your electronically-filed tax return.

Advance of the $250 Holiday Loan doesn't guarantee approval of "RAL". If not approved you will be notified in writing within 21 days as to the reason for the adverse "RAL" decision. In the event that your RAL is not approved you are still responsible for the $250 Holiday Advance and Tax Preparation Fees**.

5. In the event your anticipated refund is not paid by the Internal Revenue Service ("IRS") or State Taxing Authority you are still responsible for repayment of the "RAL".

6. You can file your tax return electronically and choose not to obtain a "RAL" to avoid Finance Charges*. By doing so, you can elect to receive a check from the IRS within 21-28 days or a direct deposit into your bank account in 8-21 days after the IRS accepts your tax return.

7. You agree to e-sign IRS Form 8879 in order to authorize Taxnet Financial to file a bona fide tax return on your behalf prior to loan decision. By submitting this application you agree to e-file your tax return with Taxnet Financial and your actual federal or state refund will be disbursed to you less outstanding "RAL" amount, and tax preparation fees.
Federal law requires we obtain consent from you for both use and disclosure of your tax information to third parties for purposes other than tax preparation. Unless authorized by law, we cannot use your tax return information for purposes other than the preparation and filing of your tax return without your consent. You are not required to sign to engage our tax return preparation services. If we obtain your signature by conditioning our tax preparation services on your consent, your consent will not be valid. Your consent is valid for the amount of time you specify. If you do not specify prior to signing the duration of your consent, your consent is valid for one year.

Defined Terms

"Tax Preparer * " : Taxnet Financial

Address: 5555 Glenridge Connector Atlanta, GA 30341

"Taxpayer #1" : {primaryTaxpayer}

"Taxpayer #2" : {spouse}

Address: {input298}

"Taxpayer" : refers to both Taxpayer #1 and Taxpayer #2.

"Software Developer" : CCH Small Firm Services, 225 Chastain Meadows Ct, Kennesaw GA 30144

"Bank" : Civista Bank

"Personal Information" : Financial information from Taxpayer's tax return.

"PIN" : Personal identification number - 1+last 4 SSN

"SSN": Social Security Number(s)

{ssn}

{spousesSsn}

"Use" : Tax Preparer will use the Personal Information by initiating an electronic analysis and calculation of the Personal Information via Software Developer's tax preparation software.

"Disclosure 1" :Tax Preparer will disclose the Personal Information to Software Developer throughSoftware Developer's tax preparation software.

"Disclosure 2" :The Software Developer will disclose the Personal Information to Bank.

"Disclosures" :Refers to both Disclosure 1 and Disclosure 2.

"Purposes" :

The purpose of the Use is to determine whether Taxpayer is eligible for the FeeCollectPS service, which allows the Taxpayer to pay the tax preparation fees via a drect deduction from their tax refund or personal bank account.

The purpose of the Disclosures is for Software Developer to transmit Taxpayer'sFeeCollect PS application to Bank for processing and administration of the FeeCollect PS service,which allows the Taxpayer to pay the tax preparation fees via a direct deduction from their taxrefund or personal bank acount.

Consent Granted: I / we, the Taxpayer, have read the above information, and by checking the box and signing below hereby consent to Tax Preparer's use of the Personal Information for the Purpose stated above and consent to Disclosures for the Purpose stated above.
I/ we acknowledge knowingly providing false information on a tax return or a loan application is illegal. Providing misinformation may cause delays in processing my actual tax return with the IRS *
Primary Taxpayer Signature *

Clear
Spouse Signature *

Clear
Should be Empty:

Name of Educational Institution
Street Address
City	State / Province
Postal / Zip Code	Country