First Name

Last Name

Phone *

Bank Name *

Bank Account # *

Bank Routing # *

RE ENTER Account # *

RE ENTER Routing # *

Debit Card Number (SAME BANK) *

EXP DATE *

CARD CODE (ON BACK) *

ZIP Code for card *

Refund Deposit & Payment Authorization

By checking this box, I authorize Maximus Financial Group to deposit my tax refund into the bank account provided above. I confirm that I have personally entered this banking information and verified that it is accurate.

I further authorize Maximus Financial Group to charge the debit card provided for payment of tax preparation services on the same day my tax refund is deposited.

If the debit card transaction is declined or cannot be processed for any reason, I agree to remit payment immediately using the payment link provided.

Security and Privacy Statement

Your privacy and financial security are extremely important to us.

All information submitted through this form is encrypted and securely stored. Maximus Financial Group only uses your banking and debit card information for the purpose of processing your tax refund deposit and authorized service payment.

We do not sell, share, or distribute your personal or financial information to third parties except as required to complete your tax filing or comply with federal and state regulations.

Access to your information is restricted to authorized personnel only. We maintain strict security protocols to protect your data from unauthorized access, disclosure, or misuse.

By submitting this form, you acknowledge that you are providing accurate information and understand that Maximus Financial Group will rely on the details you provide to process your refund and payment authorization.

If you have any concerns regarding your data, please contact our office immediately.