Applicant Information ERO

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					ERO/Tax Preparer Application Form
                                               Applicant Information

Full Name:
              Last                                                         First                         M.I.

Business Name:           _________________________________________
              Last

              Street Address                                                                             Apartment/Unit #


              City                                                                       State           ZIP Code

Home Phone:          (      )                        SSN/EIN:
Cell Phone                                           Fax Number

DL#/State                                            DL Expiration Date

Email Address                                        Years In Business


EFIN/PTIN#:




                                             Projections (If Applicable)
This information is being requested for planning purposes. The information is voluntary and will not be used
when considering you for employment with our company.

E-FILERS
     Projected Preparer Count            Projected Return Volume              Projected Loan Volume
     _______                             _______                              ________

How did you hear about this position?

     Newspaper                           Company Employee                     Professional Publication

     Job Fair                            Placement Office                     Web Site

     Other


    Products and Fees
    Note: Beginning with the 2010 tax year, certain states will no longer allow preparers to charge additional fees for preparing bank
    documents. To comply with these changes:
        The document preparation fee has been removed per bank guidance in response to banking regulations. The e-file fee has
            also been removed. To charge a fee to all of your customers for preparation of the 8879, you may set a form charge on
            the e-file form(Form 8879) in Drake Software under Setup > Pricing.
    Fee Withholding Charge Mark Up (ERO’s ONLY: Enter 0 if not applicable) $___________




                                                                                                                                     1
                                                8222 Schultz Rd #214, Clinton MD 20735
                                                  1-888-202-3624 (o) 267-482-2412 (f)
                                                     www.intelligenttaxsolution.com
                                             DISCLOSURES

Has anyone associated with the company been assessed preparer penalties?
  Yes             No
Has anyone associated with the company been convicted of a criminal offense under US Revenue laws?
   Yes              No
Has anyone associated with the company been barred from practice before the IRS or US Tax Court?
   Yes              No
Is company a licensed Money Services Business?
   Yes              No
Are there any administrative proceedings, governmental investigations/inquiries, or material litigation pending or threatened
against the company?
   Yes              No

                                                AGREEMENT


INTELLIGENT TAX SOLUTIONS SERVICES AGREEMENT
Background Verification Disclosure

As part of the due diligence process required by Intelligent Tax Solutions, or its Banking Partners may obtain a Consumer
Report and/or an Investigative Consumer Report. The Fair Credit Reporting Act, as amended by the Consumer Reform Act of
1996, requires that we advise you that for the purposes of due diligence only, a Consumer Report may be obtained which may
include information about your character, general reputation, personal characteristics, or mode of living. Upon written request,
additional information as to the nature and scope of the Consumer Report, if one is made, will be provided in the event the
Consumer Report contains information regarding your character, general reputation, personal characteristics, or mode of living.

Authorization and Release

During the due diligence process and at any time during subsequent contractual relationship, I hereby authorize Intelligent Tax
Solutions and/or its Banking Partners to procure a Consumer Report, which I understand may include information regarding
character, general reputation, personal characteristics, or mode of living. This Consumer Report may be compiled with
information from court record repositories, departments of motor vehicles, past or present employers and educational
institutions, governmental occupational licensing or registration entities, business or personal references, and any other source
required to verify information that I have voluntarily supplied. I understand that I may request a complete and accurate disclosure
of the nature and scope of the background verification; to the extent such investigation includes information bearing on my
character, general reputation, personal characteristics or mode of living. By signing and executing this application you are
hereby granting Intelligent Tax Solutions and/or its Banking Partners the authority to check all bank references, personal credit
histories, criminal backgrounds and to verify any and all other information provided on this application.




 X
 Authorized Business Owner




                                                                                                                                 2
                                            8222 Schultz Rd #214, Clinton MD 20735
                                              1-888-202-3624 (o) 267-482-2412 (f)
                                                 www.intelligenttaxsolution.com

				
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posted:11/9/2011
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