EFIN AND BANK ENROLLMENT FORM TEMPLATE

Software Choice

Renewal

Name

First NameLast Name

CONTACT PHONE NUMBER

Please enter a valid phone number.Format: (000) 000-0000.

PERSONAL EMAIL ADDRESS

example@example.com

EFIN# if you have multiple numbers please list them here separately by comma. Ex. 00000, 00000, 00000, etc.

PTIN#

COMPANY NAME

BUSINESS FORMATION TYPE

EFIN OWNER FIRST NAME

EFIN OWNER LAST NAME

EFIN HOLDER TITLE

EFIN ISSUED ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

IRS TRACKING NUMBER (found on Efile summary page)

OWNER OFFICE PHONE NUMBER

Please enter a valid phone number.Format: (000) 000-0000.

OWNER HOME PHONE NUMBER

Please enter a valid phone number.Format: (000) 000-0000.

OWNER CELL PHONE NUMBER

Please enter a valid phone number.Format: (000) 000-0000.

OWNER FAX NUMBER

Please enter a valid phone number.Format: (000) 000-0000.

OWNER EMAIL

example@example.com

OWNER SSN

Date of Birth

Owner State Photo ID

EFIN LETTER FROM IRS

What is your EFIN Registered Under? (EFIN or SSN)

COMPANY EIN (employer identification number) IF APPLICABLE

Name of Financial Institution

NAME ON ACCOUNT

TYPE OF ACCOUNT

ROUTING NUMBER

ACCOUNT NUMBER

PRIMARY USE OF ACCOUNT?

OFFICE PHONE NUMBER

Please enter a valid phone number.Format: (000) 000-0000.

CELL PHONE NUMBER

Please enter a valid phone number.Format: (000) 000-0000.

COMPANY NAME (must be the same above)

FAX NUMBER

Please enter a valid phone number.Format: (000) 000-0000.

EMAIL ADDRESS

example@example.com

OFFICE MANAGERS FULL NAME

First NameLast Name

OFFICE MANAGER'S EMAIL ADDRESS

example@example.com

OFFICE MANAGER'S SSN

OFFICE MANAGER'S DATE OF BIRTH

# OF YEARS AT CURRENT ADDRESS

# OF YEARS E-FILING

# OF YEARS WITH BANK PRODUCTS

# OF OFFICE PERSONELL

WHERE WOULD YOU LIKE THE CHECK MAILED IF DIRECT DEPOSIT ERROR OCCURS?

EFIN AND BANK ENROLLMENT

EFIN HOLDER INFORMATION

FINANCIAL INFORMATION

OFFICE INFORMATION

ADDRESS INFORMATION

MAILING INFORMATION

SHIPPING INFORMATION

PHYSICAL LOCATION INFORMATION

PRIOR YEAR STATS AND FEES (if applicable)

SOFTWARE FEES