Tax Resolution Questionnaire

We are here to help you! Please take a few minutes to fill out this form. We will review and respond promptly to schedule an initial meeting to discuss the scope of your business and/or individual needs.

First Name
Last Name
Marital Status
  • - select a option -
  • Single
  • Married
  • Divorced
  • Widowed
Spouse First Name
Spouse Last Name
Address, City, State, and Zip Code
Phone Number
Phone Number
Cell Number
Fax Number
Email Address
Birth Date
Do you have children?
  • - select a option -
  • Yes
  • No
If so, how many?
With whom are you having issues?
  • - select a option -
  • IRS
  • State
  • Both IRS & State
  • Other
What type of issues are you having?
  • - select a option -
  • Owe money and can't pay
  • Disputing a charge
  • Seizure of Property
  • Liens / Levies
  • Revenue Officer contacted you
  • Need a penalty abatement
  • Need prior year(s) tax filing
  • Current tax filing needed
  • Identity theft
  • Innocent spouse
  • Currently being audited
  • Need audit reconsideration
  • Need a substitute for return submissions
  • Business tax issues
How much do you think or know you owe to the IRS?
  • - select a option -
  • Don't Know
  • Less than 30k (Our resolution fee is $1875)
  • More than 30k (Our resolution fee: $3500)
  • More than 50k (Our resolution fee: $5600)
  • More than 100k (Our resolution fee $6500)
  • Doesn't applyto me
How much do you think or know you owe to the State?
  • - select a option -
  • Don't Know
  • Less than 30k
  • More than 30k
  • More than 50k
  • More than 100k
  • Doesn't apply to me
Estimated monthly disposable income (after bills)
Do you have any equity?
  • - select a option -
  • Yes
  • No
If yes, what type?
  • - select a option -
  • Cash
  • IRA
  • 401k
  • Credit Lines
  • Homes
  • Multiple Sources
  • Other
Total amount of equity?
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