Tax Preparer Questionnaire
Join Empowered Tax & Services LLC
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
Which of our services are you interested in?
*
Tax Preparer
Tax Advocate
Life Insurance Agent
PTIN HOLDER
Are you a PTIN holder?
*
Yes
No
Do you have TAX PREP experience?
*
YES
NO
Are you willing to INVEST approximately $31.00 to obtain PTIN?
*
YES
NO
Do you have a VAILD DRIVERS LICENSE or IDENTIFICATION CARD
*
YES
NO
Do you have Social Security Card?
*
YES
NO
Have you been convicted of a Felony or Misdemeanor? (may not obtain PTIN)
*
YES
NO
Do you have life insurance?
*
YES
NO
How did you hear about us?
*
Referral
Direct Mail
Online Add
Sales Call
Print Add
Other
Attachment
*
Browse Files
Drag and drop files here
Choose a file
Please include any attachments (e.g., logo, mission statement, annual report, etc.) that would help us better understand your company's needs.
Cancel
of
Your Note
Signature
*
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