Full Legal Name of the Business:
Type of Business:
Legal Structure: ---S CorporationC CorporationNon_Profit or Tax ExemptPartnershipSole ProprietorshipLLC-Limited Liabilty
Mailing Address line one:
Suite or Internal Mail Stop/Code:
City:
State:
Zip code:
Business Telephone with Extension:
Private Telephone with Extension:
Business Cellular Phone:
Salutation: ---Mr.Mrs.MissPartnershipSole ProprietorshipMs.
First Name:
Last Name:
Email:
Business Title:
Mailing Address:
Suite or Apartment:
Home Telephone:
Cellular Telephone:
Telefax:
Type of tax owed: ---Unfilled PersonalUnpaid BusinessUnpaid PayrollTaxes assessed by IRSOther
What years are Involved:
Approximate Amount: ---$1,000 ~ $15,000$15,000 ~ $25,000$25,000 ~ $50,000$50,000 ~ $100,000$100,000 or More
The best time to contact: ---Weekdays Morning 9:00Weekdays Afternoon 12:00Weekdays Evening 6:00Saturday 10:00 to 5:00
Please contact me by: ---Office TelephonePrivate Business TelephoneBusiness CellphoneHome TelephonePersonal Cellphone
I have been audited
I have been levied through My bank AccountI have been levied through My Payroll Earnings
I have not filed my tax returns
I have not received notices of levies and/or lien
Additional Information