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Spouse Information

Dependent 1

IF YOU ARE CLAIMING A DEPENDENT, PLEASE ANSWER THE QUESTIONS BELOW THAT PERTAINS TO YOUR DEPENDENT RELATIONSHIP. PER THE IRS REQUEST, WE MUST PROVE THAT NOBODY ELSE IS ELIGIBLE TO CLAIM YOUR DEPENDENT BUT YOURSELF.

Bank Information

I hereby state that all the information I have provided is true and accurate to the best of my knowledge. I authorize Eleven13 Firm to prepare my taxes based on this information. I understand that I am financially responsible for any outstanding balance resulting from false or incomplete information provided by me.

If there is a balance due, the tax preparation fee must be paid upfront. If, for any reason, you owe an entity and they take your entire refund, you are STILL responsible for paying the tax preparation fee for services rendered.

*If an amendment needs to be filed for reasons not caused by the tax preparer, an upfront fee of $150.00 will apply. Please review your tax return, which will be emailed to you prior to submission. Additional copies after the first are subject to a $10.00 fee.

ALL FEES (including bank and service fees) are clearly listed in your return and are non-refundable and non-negotiable. NO EXCEPTIONS.

For federal refund tracking, please visit www.irs.gov. For state refunds, visit your state’s Department of Revenue website. Do NOT combine federal and state refund amounts when tracking your status. Please allow 8 weeks from the date of submission before contacting the IRS for updates.

For any direct assistance, please email [email protected].

IRS Contact: 800-829-1040

To check your federal refund status, click the link below. You will need your filing status, Social Security Number, and the total refund amount before fees:
https://sa.www4.irs.gov/irfof/lang/en/irfofgetstatus.jsp

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