TAX RESOLUTION PROSPECT INTAKE FORM

TAX RESOLUTION PROSPECT INTAKE FORM
Date

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
How did you hear about us?

AttorneyCPAFriend or FamilyAdvertisingOther
Does the IRS claim you owe $10,000 or more?*

YesNoNot sure
Does the State claim you owe $10,000 or more?*

YesNoNot sure
Do you have unfiled tax returns?

YesNo
Have your wages been garnished, or your bank accounts been levied yet?

YesNo
Appointment
Would you like your appointment to be:

In officeZoom meetingPhone call
PAYMENT INFORMATION

A credit card is required to book your appointment. Your appointment cannot be booked until after you contact our office at 414-219-9909 with your credit card information. Our hours are Mon - Fri, 8 am - 5 pm Central Time

Please note:

We have a 24-hour cancellation policy. If you do not contact us to cancel within 24 hours of your appointment, we will charge $99 for the missed appointment.
Should be Empty: