EFIN AND BANK ENROLLMENT FORM TEMPLATE

Name*

First NameLast Name

CONTACT PHONE NUMBER*

Please enter a valid phone number.

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*

SOLE PROPPARTNERSHIPLLCOTHER

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.

OWNER HOME PHONE NUMBER*

Please enter a valid phone number.

OWNER CELL PHONE NUMBER*

Please enter a valid phone number.

OWNER FAX NUMBER

Please enter a valid phone number.

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)*

EINSSN

COMPANY EIN (employer identification number) IF APPLICABLE

Name of Financial Institution *

NAME ON ACCOUNT*

TYPE OF ACCOUNT*

CHECKINGSAVINGS

ROUTING NUMBER*

ACCOUNT NUMBER*

PRIMARY USE OF ACCOUNT?*

BUSINESSPERSONAL

OFFICE PHONE NUMBER*

Please enter a valid phone number.

CELL PHONE NUMBER*

Please enter a valid phone number.

COMPANY NAME (must be the same above)*

FAX NUMBER

Please enter a valid phone number.

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?*

TAXPAYEROFFICE ADDRESSPARENT OFFICE ADDRESS

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