TAX RESOLUTION PROSPECT INTAKE FORM
Date
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
How did you hear about us?
Attorney
CPA
Friend or Family
Advertising
Other
Does the IRS claim you owe $10,000 or more?
*
Yes
No
Not sure
Does the State claim you owe $10,000 or more?
*
Yes
No
Not sure
Do you have unfiled tax returns?
Yes
No
Have your wages been garnished, or your bank accounts been levied yet?
Yes
No
Appointment
Would you like your appointment to be:
Zoom meeting
Phone call
Preview PDF
Submit
Should be Empty: