Free Extension Request Form

Optimum Financial Services (formerly Quality Tax) - Free Extension Request Form

Are you a New or Returning Customer *

New Customer

Returning Customer

First Name *

Last Name *

Date of birth

SSN #

I/We hereby agree that by providing this information to Optimum Financial Services (formerly Quality Tax) for a FREE or PAID TAX EXTENSION, I/we will file our 2024 tax return with Optimum Financial Services by November 03, 2025. If I/We file our 2024 taxes elsewhere OR FAIL TO FILE, I/We understand that there will be a charge of $79. This fee must be paid out of pocket within 7 days after the failed attempt to adhere to the agreement stated above, or the debt will be sent to a third-party collection agency. The $79 charge will be applied on November 10, 2025.

It's important to note that a FREE or PAID Extension only gives you an extension to file, but it does not extend the deadline to pay any taxes that may be due. If you owe taxes, it's essential to pay them before the due date to avoid potential failure-to-file and failure-to-pay penalties, as well as interest on the amount owed.

I also agree to allow Optimum Financial Services to charge me a Extension Fee if I do not qualify for a FREE Extensiton TODAY using my banking information below:

Simple Return: W2s Only = $0 Extension Fee

Basic Return: Basic Tax Return = Dependents, W2s, 1098T, EIC, CTC, ACTC, Day Care Credit, Social Security, Unemployment, Student Loans, IPPIN Letter just to name a few forms = $25 Extension Fee

Complex Return: Schedule C (small business),1099NEC, 1099K, 1099MISC, Schedule A (itemizing), Real Estate, Investments & Income, Retirement 1099R, Gambling Wins & Losses, HSA, 1099C, 1095A Health Insurance, 1099C, 1st Home Buyers Credit, 1099INT, 1099DIV, SCorp, Partnership, Nonprofit, Estimated Taxes, Daycare Credit, Educator Expense, IRA Distributions or Contribution, Capital Gains & Losses, Farming, Adoption Credit, K1, Household Help just to name a few forms = $75 Extension Fee

Bank Name

Bank Account Number

Routing Number

BILLING ADDRESS

Street Address

City

Country

State

Postal Code

Are you legally married/have you ever been legally married? *

Yes

No

If yes, did you live with your spouse last 6 months of 2024?

Yes

No

Does either person need to complete an injured/innocent spouse form (8379)? *

Yes

No

If Yes, WHY?

If filing with your spouse include their information below. If not filing with spouse, explain WHY? *

Spouse First Name

Spouse Middle Name

Spouse Last Name

Spouse SSN #

Spouse Date of Birth

Home Address if different from Billing Address Above

Address

Street Address

City

State

Country

Postal code

Phone *

Tax Payer E-mail Address *

Current Occupation *

Additional Reliable Contact Number

Spouse Occupation

Spouse Email Address

Did You File Taxes Last Year?

Yes

No

Can someone else claim YOU/ YOUR SPOUSE as a dependent? *

Yes

No

Are you and/or Spouse U.S. Citizen? *

Yes

No

Provide a copy of everyone’s Social Security Card(s) Taxpayer, Spouse and Dependents?

Yes

No

Please attach here (ATTACHMENTS ARE NOT REQUIRED AT THIS TIME)

Provide a copy of You &/or Your Spouse's Driver's License(s) *

Yes

No

Please Attach Here * *

Do you or your spouse have an IRS IP PIN?

Yes

No

Does Not Apply

Did you own your own small business/ home based business/ or are an independent contractor and need to claim your income & expenses (Schedule C)?

Yes

No

Please attach here (ATTACHMENTS ARE NOT REQUIRED AT THIS TIME)

Do you have itemized expenses (Schedule A)? (I.e. medical bills, tithes & offering, car tags, union dues and so forth)

Yes

No

Please attach here (ATTACHMENTS ARE NOT REQUIRED AT THIS TIME)

Did you draw from a 401K (1099-R)? Yes or No

Taxpayer:
Spouse:

Type Yes or No

Please attach proof if applies (ATTACHMENTS ARE NOT REQUIRED AT THIS TIME)

Did you pay into a Health Saving Account HSA (Line 25)?

Yes

No

Please attach proof if applies (ATTACHMENTS ARE NOT REQUIRED AT THIS TIME)

Did you pay into an IRA (Line 32)?

Yes

No

Please attach proof if applies (ATTACHMENTS ARE NOT REQUIRED AT THIS TIME)

Did you pay for any higher education expenses for yourself or any of your dependents (1098T/ 8863)?

Yes

No

Do you have a 1098T from the school?

Yes

No

Please attach proof (ATTACHMENTS ARE NOT REQUIRED AT THIS TIME)

Did you pay any interest for student loans?

Yes

No

Please attach proof if applies (ATTACHMENTS ARE NOT REQUIRED AT THIS TIME)

Did you/spouse receive any unemployment pay?

Yes

No

Please attach proof if applies (ATTACHMENTS ARE NOT REQUIRED AT THIS TIME)

Did you/spouse receive social security benefits?

Yes

No

Please attach proof if applies (ATTACHMENTS ARE NOT REQUIRED AT THIS TIME)

If You’re Not Claiming Dependents SKIP this section

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Dependents relationship to you must be your son, daughter, adopted child, foster child, stepchild or a descendant of any of them, such as a grandchild, or your brother, sister, stepbrother, stepsister, half-brother or half-sister, or a descendant of any of them, such as a niece or nephew.

Claim any Dependants?

Yes

No

How Many Dependants? (Up to 4)

Dependant 1 First Name

Dependant 1 Last Name

Dependant 1 Date of Birth

Dependant 1 SSN#

Dependant 1 Relationship to you

Dependant 1 # of Month in Home in 2024

Dependant 2 First Name

Dependant 2 Last Name

Dependant 2 Date of Birth

Dependant 2 SSN#

Dependant 2 Relationship to you

Dependant 2 # Months in Home in 2024

Dependant 3 First Name

Dependant 3 Last Name

Dependant 3 Date of Birth

Dependant 3 SSN#

Dependant 3 Relationship to you

Dependant 3 # Months in Home in 2024

Dependant 4 First Name

Dependant 4 Last Name

Dependant 4 Date of Birth

Dependant 4 SSN#

Dependant 4 Relationship to you

Dependant 4 # Months in Home in 2024

Amount paid to daycare per child, name of daycare and daycare EIN or SSN (if applies) (Form 2441)

Earned Income Credit Due

Diligence Section

Dependent's Birth Certificate(s)

Dependent's Social Security Card(s)

Proof that dependent is not your biological child

Was your Earned Income Credit Disallowed (Form 8862)?

Yes

No

If yes, WHY and what tax year?

If you are a single parent please explain where the other dependents parent is. Explain if they can claim any of the dependents and if not why.

Was your home the main home of all qualifying dependents (more than half the year)?

Yes

No

If NO, cannot claim EIC.

If dependent is not your biological child, explain why the biological parents are not claiming them?

If dependent(s) is/are not your biological child/children can you provide proof of residency documentation/proof supporting that you can claim dependent if requested by the IRS?

Yes

No

Are the qualifying dependents on return U.S. citizens?

Yes

No

Did you pay more than half the cost of maintaining your home and supporting all dependents throughout the 2024 tax year?

Yes

No

If a dependent is disabled please explain the type of disability and how long the dependent has been disabled. Does the dependent receive social security benefits? Do you have proof from a doctor or proof of social security benefits? How long will the disability last?

Do you receive any government assistance?

Yes

No

If yes, what type & how much?

For dependents over 19 years of age: were they a full-time student during 2024?

Yes

No (If no, the dependent does not qualify you for the EIC unless they were disabled)

I would like my federal and/or state refund as

A Check

Cash Card

Direct Deposit

Upload any files you have not uploaded

Client Agreement & Authorization for Tax Preparation Services

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This document serves as an agreement between you the Client Name and Optimum Financial Services (OFS) for the preparation of your tax year(s) you are currently filing individual federal and state tax returns and any prior year tax returns that you may need.

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Accuracy and Responsibility: By signing below, you affirm that all information provided on the OFS Client Profile Sheet and accompanying packets is true, correct, and accurate to the best of your knowledge. You acknowledge receiving copies of bank forms, your 1040 Forms, state documents, and relevant protection plus documents. It is understood that any differences between the information in Quality Tax Pro Software being used by Financial Powerhouse LLC dba Optimum Financial Services and the provided packets shall override information in these packets based on as the differences may come from verbal communications with the clients, as allowed under Circular 230.

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Confidentiality and Dependents: OFS guarantees the confidentiality of all information provided to our office. By signing below, you affirm that all dependents listed in this application are legally yours and that you possess appropriate documentation, if required.
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Preparation and Filing: Optimum Financial Services will prepare your tax return based on the information provided. We do not alter, audit, or verify the information furnished. You, the taxpayer, bear ultimate responsibility for the accuracy and filing of your tax return. In case of misrepresentation leading to an audit, you are solely responsible for any consequences arising thereof.
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Fees and Submission: You acknowledge and understand all fees charged for the services rendered. You grant OFS permission to submit your return to the IRS as deemed necessary. Additionally, by signing, you authorize the application of fees to any remaining refund if your return undergoes processing through the bank (state or federal) after any applicable debts or offsets.
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Authorization for E-Signature: You provide consent for OFS to use your e-signature on your behalf in relation to the tax year(s) you are currently filing a tax return for.
By signing below, you acknowledge that you have read, understood, and agree to the terms outlined in this Client Agreement and Authorization for Tax Preparation Services.
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By signing below I/We hereby acknowledge that the information provided within on this PACKET FOR A EXTENSTION ON MY TAX RETURN is true and correct.

Free Extension Request Form Taxpayer Signature: *

Clear

Sign Here

Free Extension Request Form Spouse Signature

Clear

Sign Here

Free Extension Request Form Date of Signing

Anything in Optimum Financial Services software will override anything in this packet based on verbal communications allowed by IRS Circular 230.

Optimum Financial Services (formerly Quality Tax) - Free Extension Request Form

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