CLIENT INTAKE FORM — COVID-ERA IRS PENALTY REFUND CAMPAIGN

Please select what transcripts will be reviewed for refunds/abatements:
How many business entities are you including?
"If you have 5 or more entities, we would like to personally onboard you to make the process most efficient for you."
📞 Dave Manges — (214) 235-6462
📞 Asher Ladner — (214) 783-1097
"Please give us a call and we will gather the information needed to get you started right away!"
Expand each section below to complete the required information for the engagement.
- Name
  
  First NameLast Name
- Title/Role
  e.g. CEO, Owner, CFO, Partner, Member
- Daytime Phone
  Format: (000) 000-0000.
- Mobile / Cell
  Format: (000) 000-0000.
- Email Address
  example@example.com
- Referral Name
  (if applicable)
- Date Form Completed
  
  MonthDayYear
- Note: Your authorization will cover tax years 2010 through 2029 - this range encompasses the earliest CSED periods that would have expired in 2020 and also provides visibility into IRS transactions for the 2020-2023 COVID disaster window that may be associated with present-day periods and could require additional research.
- Business Entity #1
- Legal Business Name
  (as on IRS records)
- DBA / Trade Name
  (if different)
- EIN (Employer Identification Number)
- Entity Type
- State of Incorporation
- Business Street Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Business Phone
  Format: (000) 000-0000.
- Add additional entity information:
  
  Click here Reinsman — Business Entity Information to complete the additional entity form. When complete, save it as a pdf and upload the file in the portal below.
- Additional Entity Information Upload
  
  Upload the completed template file here.
  Cancelof
- Note: Your authorization will cover tax years 2010 through 2029 - this range encompasses the earliest CSED periods that would have expired in 2020 and also provides visibility into IRS transactions for the 2020-2023 COVID disaster window that may be associated with present-day periods and could require additional research.
- Taxpayer Full Name
  
  First NameMiddle NameLast Name
- Social Security Number (SSN)
- Date of Birth
  
  MonthDayYear
- Daytime Phone
  Format: (000) 000-0000.
- Filing Status (most recent year)
- Home Address (if different from business)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Include Spouse / Joint filer information?
- Spouse Full Name
  
  First NameMiddle NameLast Name
- Spouse SSN
- Spouse Date of Birth
  
  MonthDayYear
- Spouse Phone
  (if different)Format: (000) 000-0000.
- Spouse Email
  (if different) example@example.com
- Spouse Address (if different)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Authorization Statement: By signing below, I authorize Reinsman Business & Tax Advisory, LLC / Reinsman Tax Resolution, LLC to generate an engagement letter and Forms 8821/2848 for signature.
  
  I understand that: (a) Reinsman's fee is 100% contingency-based and no fee is owed unless and until the IRS grants a refund or penalty abatement; (b) if no refund or abatement opportunity is identified, there is no cost to me; (c) the IRS will review all claims before any refund is issued; and (d) filing a Form 843 claim does not terminate any active installment agreement.
  
  I confirm that all information provided on this form is accurate and complete to the best of my knowledge and belief.
- Authorized Signer - full legal name
  
  First NameLast Name
- Title
  e.g. CEO, Owner, Partner, Member (if part of an LLC)
- Date Signed
  
  MonthDayYear
- Signature
- Spouse Legal Name
  
  First NameLast Name
- Date Signed
  
  MonthDayYear
- Spouse Signature
For questions or additional help, click here to send us an email:

info@reinsmanconsulting.com
Should be Empty:

"If you have 5 or more entities, we would like to personally onboard you to make the process most efficient for you."

📞 Dave Manges — (214) 235-6462

📞 Asher Ladner — (214) 783-1097

"Please give us a call and we will gather the information needed to get you started right away!"

Business Entity #1