PurposeTax Software and Solutions Referral Form:
Tax Software, Service Bureau, Tax Partner, Mentorship, Tax Preparer, Tax Class Intake Form
What services are you interested in?
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Software Purchase
Becoming a Tax Preparer
Becoming a Tax Partner
Becoming a Service Bureau
What services are you interested in?
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Software Purchase
Becoming a Service Bureau
Becoming a Tax Partner
Becoming a Tax Preparer
Becoming a Affiliate
Tax Class
EFIN Assistance
Mentorship
Office Training
Who referred you or How did you hear/learn about our services?
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First name of Business Owner and/or Tax Preparer (Required)
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Last name of Business Owner and/or Tax Preparer (Required)
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Social Security Number of Business Owner and/or Tax Preparer (Required)
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If you are not comfortable with providing this information at this time please type generic social security number 999-99-9999 or 123-45-6789
Date of Birth of Business Owner and/or Tax Preparer (Required)
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/
Month
/
Day
Year
Date
Driver License Number/State/Issuance and Expiration Date of Business Owner and/or Tax Preparer (Required)
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If you are not comfortable with providing this information at this time please type a generic Driver License/ID number 99999999 or 12345678
Address of Business Owner and/or Tax Preparer (Required)
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Email Address of Business Owner and/or Tax Preparer (Required)
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Phone Number of Business Owner and/or Tax Preparer (Required)
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Business Name (As Listed with State on LLC/INC or on DBA, if not established type N/A)
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Business Address(Required)
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Business Phone Number(Required)
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Business Email(Required)
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First name of EFIN Holder as listed on EFIN Application (Required, if you do not have an EFIN type N/A)
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Last name of EFIN Holder as listed on EFIN Application (Required, if you do not have an EFIN type N/A)
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Social Security Number of EFIN Holder as listed on EFIN Application (Required, if you do not have an EFIN type N/A)
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If you are not comfortable with providing this information at this time please type generic social security number 999-99-9999 or 123-45-6789
Date of Birth of EFIN Holder as listed on EFIN Application (Required, if you do not have an EFIN type N/A)
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/
Month
/
Day
Year
Date
Driver License Number/State/Issuance and Expiration Date of EFIN Holder (Required, if you do not have an EFIN type N/A)
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If you are not comfortable with providing this information at this time please type a generic Driver License/ID number 99999999 or 12345678
Address of EFIN Holder (Required, if you do not have an EFIN type N/A)
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BANKING INFORMATION (For Bank Application Product and Direct Deposit of Fee Disbursement and Agreements)
Name on Bank Account/Owner(Type N/A if does not applies)
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Banking Institution Name(Type N/A if does not applies)
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Banking Information (For Bank Application Product and Direct Deposit of Fee Disbursement and Agreements) Routing Number
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Banking Information (For Bank Application Product and Direct Deposit of Fee Disbursement and Agreements) Account Number
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Banking Information (For Bank Application Product and Direct Deposit of Fee Disbursement and Agreements) Bank Account Type
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Checking
Savings
Did you verify and confirm your banking information which includes (Bank Name, Routing and Account Number, Account Type) for accuracy, as PurposeTax Software and Consulting Services is not responsible for any typos, inaccuracy or IRS delays due to inaccurate information
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Yes
No
Questionnaire
Have you done taxes before?
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Yes
No
If yes, how long?
If yes, which type of returns and/or forms have you done or are familiar with?
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Minimum Experience
Basic Tax Preparation
1040 Individual Tax Return
1120- S (Single Member LLC. Elected to be taxed as Corporation)
1120 Corporation Tax Return
1065 Partnership Tax Return
Schedule C Business Income and Expenses Reporting
Experienced in all returns and schedules
How are you established as a Tax Business Owner,Tax Partner,Tax Preparer, Marketer and/or Service Bureau?
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Physical Location-Brick and Motar (Retail/Office Space)
Mobile
Virtual
Do you have a active PTIN (Preparer Identification Number)?
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Yes
No
If yes, how long?
PTIN Number (Type N/A if you don't have an PTIN)
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Have you ever had your PTIN (Preparer Identification Number) compromised,suspended or revoked?
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Yes
No
If yes, which status, when and what action was taken and the outcome?
Do you own your own Tax Business or have you ever owned a Tax Business?
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Yes
No
Previously Owned/Owned Before
If yes, how long have you been in business or were in business and if your not in business anymore give a brief explanation as to why?
Do you have an active EFIN (Electronic Filing Number) or have you ever had or applied for one?
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Yes
No
Applied, awaiting answer
Had one before, Inactive
Have applied before
Was denied
Filed an appeal
If yes, how many do you have, how long have you had it and/or when did you get one and/or when did you apply?
EFIN Number(s)( Type N/A if you don't have an EFIN)
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How many EFIN Numbers do you have or had? List EFIN numbers, status and the year recieved.
Have you ever had your EFIN (Electronic Filing Number) compromised, suspended or revoked?
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Yes
No
If yes, which status, when and what action was taken and the outcome?
Are you under or have you ever been in contract and/or breached, suspended or terminated an contract with a Tax Office/Service Bureau/Business Owner while being associated with them as a preparer whether consultant, contract or employee?
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Yes
No
If yes, which Tax Office/Service Bureau/Business were you partnered/associated/employed/contracted with, when (from and to/start to end/ month and year), what action was taken and the outcome?
Which Tax Software have you used and worked with before?
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Which version of software do you prefer?
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Hosted
Cloud Based
Installed/Desktop
Which tax software integrated provider are you interested in?
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Crosslinx
Taxslayer
Unsure
How many offices do you have?
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Are you interested in having subsites (additional offices)?
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Yes
No
If yes, how many subsites (additional offices) are you interested in or do you have?
Are you under or have ever been in contract and/or breached or terminated an contract with a software provider?
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Yes
No
If yes, which software provider were you partnered with, when did it occur(month and year), what action was taken and the outcome?
Which banking partner are you interested in and/or do want to partner with to utilize and offer banking products?
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TPG Santa Barbara
Refund Advantage
Refundo
Republic Bank
Unsure
Select which Banks you have partnered with before to utilize and offer banking products.
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TPG Santa Barbara
Refund Advantage
Refundo
Republic Bank
EPS Bank
Axos Bank
Not Listed
Have you ever went through a bank audit?
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Yes
No
If yes, which bank were you partnered with, when did it occur(month and year), what action was taken and the outcome?
Has your banking agreement ever been terminated by a banking partner during and/or after tax season?
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Yes
No
If yes, which bank were you partnered with, when did it occur(month and year), what action was taken and the outcome?
Have you ever went through an IRS audit?
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Yes
No
If yes, why was the audit triggered and/or conducted, which tax software were you using, which banking product were you partnered with, when did it occur(month and year), what action was taken and the outcome?
What is your estimated count of tax returns processed from last tax year?
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What is your estimated count of tax returns funded from last tax year?
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What is your goal and/or estimated count of tax returns to complete this upcoming tax year?
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Upload Driver License of Business Owner or Tax Preparer
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Upload Driver License of EFIN Holder
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Upload EFIN Accepttance Letter or Application Summary
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Signature
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Date
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Thank you for contacting our office where we are here to help you scale your tax preparation skills and business to the next level. Someone from our office will contact you within 24-48 hours of receiving your submission form to go over intake process, available packages, your options, tax software, service bureau and tax partner opportunities, tax preparation and software classes available,mentorship and client ID and banking partner assignment and any questions you may have. Thank you for your business and support.
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