Tax Seller Servicing Application

Royalty Tax Service

1.844.826.2TAX (2829)

(Please provide a copy of last year's tax return)
DATA INPUT FORM
Taxpayer Name*

First NameMiddle NameLast Name
SSN*
DOB*
Driver's License*
Driver's License State*
Occupation*
Cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Home Phone

Area CodePhone Number
E-mail Address*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Filing Status:*

SingleMarried Filing Separated(Please fill Spouse's Name)Head of HousholdQualifying Window or Widower Spouse's date of deathMarried Filing Joint
Facebook
Spouse Name (if filing jointly or separately)

First NameMiddle NameLast Name
SSN
DOB
Driver's License
Driver's License State
Occupation
Facebook
Phone Number

Area CodePhone Number
E-mail Address
example@example.com

Dependents If any (scroll over on mobile)

Did you pay for child daycare?*

NoOther
Are you or your spouse permanently disabled?*

YesNo
Do your children reside with you but are being claimed by someone else?*

YesNo
Will you be claimed as a dependent on someone else's tax return?*

YesNo
Did you or anyone receive insurance through the market place?*

YesNo
Did you file taxes last year*

YesNo
Have you recieved a letter or notification from the IRS in the past three years?*

YesNo
Do you owe the IRS or any government agencies*

YesNo
Check those that apply

Direct Deposit (scroll over on mobile)

	Bank name	Account Type	Routing#	Account#
Direct deposit

How were you referred to us?
Where did you file last year?
Reference
Name and/or Number
Reference
Name and/or Number
Reference
Name and/or Number
Here you may upload any or all necessary documents needed to file your taxes such as W-2's, 1099's, identification, etc

Upload a File

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Ask questions or concerns regarding your tax expenses
READ AND UNDERSTAND
This firm and its employees will comply with all of the provisions of the Revenue procedure for electronic filing or individual and business income tax returns, and related publications of each year of our participation.

Under the penalty of perjury, I/We declare that I/We have read and examined this application and accompanying information, and hereby certify that the information being provided above is true, complete, correct and accurate to the best of my/our knowledge and belief.
Customer Signature*

Clear
Date
Spouse Signature

Clear
Date
Office Use Only

I hereby certify that the return was prepared with information provided to me by the taxpayer whose signature appears above.

If fraud is suspected, i will notate the file and take neccessary action.
This return was prepared by
Tax Professional Signature

Clear
Date
Should be Empty: