2026-2027 PTIN Partner Intake Form

2026-2027 PTIN Partner Intake Form

Ultimate Tax Services LLC Raeford NC
Personal Information
Full Legal Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Tax Identification Number
SSN
Mailing Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Driver's License Number
Driver's License State
Tax Preparer Credentials
PTIN Number
PTIN Expiration Date

MonthDayYear
Date
Do you have an EFIN?
If yes, what is your EFIN number?
Number of years preparing tax returns
Total returns filed last season
Have you ever had your PTIN or EFIN revoked, suspended, or denied?
If yes, please explain
Have you ever been investigated by the IRS Office of Professional Responsibility?
If yes, please explain
Do you have any felony convictions?
If yes, please explain
IRS Compliance Acknowledgment
IRS COMPLIANCE REQUIREMENTS - As a tax preparer operating under the EFIN of Ultimate Tax Services LLC you are required to comply with all applicable IRS regulations including: IRS Circular 230 standards of practice; Form 8867 Due Diligence requirements for all returns claiming EITC, CTC, ACTC, ODC, and AOTC; IRS Publication 4557 data security requirements; proper identification verification for all clients including Form 14039 identity theft protocols; and accurate reporting of all income and deductions. Failure to comply may result in immediate termination, reporting to the IRS Office of Professional Responsibility, and personal liability for any penalties assessed.
I acknowledge and agree to comply with all IRS regulations and due diligence requirements.
Tier Placement and Commission Structure
COMMISSION TIER STRUCTURE - Your commission tier is determined by verified experience and production history. Bronze Tier 40 percent commission for 0 to 24 verified returns. Silver Tier 70 percent commission for 25 to 94 verified returns with PTIN track record. Gold Tier 100 percent commission for 95 or more verified returns. Tier placement is based on verified PTIN filing history and may be adjusted after production review. Even at 100 percent commission Ultimate Tax Services LLC retains all backend fees including bank product fees and transmission fees.
Requested Tier Placement
Total verified returns from prior seasons
Upload PTIN verification document

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INDEPENDENT CONTRACTOR STATUS - You acknowledge that you are engaged as an independent contractor and not an employee of Ultimate Tax Services LLC. You are responsible for your own taxes including self-employment tax. You will not receive W-2 wages, employee benefits, health insurance, or retirement contributions from Ultimate Tax Services LLC. You will receive a 1099-NEC for all compensation earned.
CONFIDENTIALITY AND NON-SOLICITATION - You agree to maintain strict confidentiality of all client information, proprietary systems, training materials, and business processes of Ultimate Tax Services LLC. You agree not to solicit or service any Ultimate Tax Services LLC clients independently for a period of 12 months following termination within a 50-mile radius of the office location. Violation of this provision shall result in liquidated damages of $10,000 per occurrence.
DATA SECURITY - You agree to handle all taxpayer PII in accordance with IRS Publication 4557. You agree not to store client data on personal devices without encryption. You agree to immediately report any suspected data breach to management within 24 hours.
I agree to the independent contractor classification, confidentiality, non-solicitation, and data security terms.
Direct Deposit and Payment Information
Bank Name
Bank Routing Number
Account Number
Account Type
Name on Account

First NameLast Name
Payment Frequency Preference
Signature and Submission
By signing below I certify that all information provided is true and accurate. I understand that falsification of any information may result in immediate termination. I have read and agree to all terms outlined in this intake form including commission structure IRS compliance requirements independent contractor status confidentiality obligations and data security protocols. I understand my tier placement is subject to verification of my PTIN filing history.
Printed Name

First NameMiddle NameLast Name
Date

MonthDayYear
Date
Electronic Signature
Ultimate Tax Services LLC Raeford NC.
All agreements subject to LegalShield attorney review.
Should be Empty:

2026-2027 PTIN Partner Intake Form

Personal Information

Tax Preparer Credentials

IRS Compliance Acknowledgment

Tier Placement and Commission Structure

Direct Deposit and Payment Information

Signature and Submission