Refund Advance Request

Quick Refund Advance Request

Please complete this short form and our team will contact you to review your eligibility and assist you with preparing your tax return.

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Basic Information

First Name

Last Name

Phone Number

Email Address

Preferred Language

—Por favor, elige una opción—SpanishEnglish

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Information to Evaluate Eligibility

Do you plan to prepare your tax return with our office?

YesNoI'm not sure yet

Approximately how much do you think your tax refund will be this year?

—Por favor, elige una opción—Less than $500$500 – $1,000$1,000 – $3,000$3,000 – $5,000More than $5,000I'm not sure

What is your primary type of income?

—Por favor, elige una opción—W-2 employmentSelf-employed / 1099 contractorGig or app-based work (Uber, Lyft, DoorDash, Instacart, etc.)Business ownerSocial Security incomePension or retirement incomeRental property incomeCombination of multiple income sourcesOther

Do you have dependents that you will claim on your tax return?

YesNo

If yes, how many dependents?

—Por favor, elige una opción—1234 or more

Have you received your tax documents yet (W-2, 1099, etc.)?

Yes, I have all my documentsI have some documentsI have not received them yet

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Contact Preference

How would you prefer we contact you?

Phone callText messageEmail

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Consent

I understand that completing this form does not guarantee approval and that some refund advance options may include applicable fees or APR.

I understand that refund advance loans are offered by a participating bank or lending partner, and that approval, advance amount, and funding timing depend on eligibility requirements and verification of my tax return information.