| Type of Tax? |
|
|
| *
Collection Issue
(i.e. owes money) or Audit? |
|
| *
Balance Due? |
|
| Are there any delinquent
returns? |
|
| *
What taxing
authority is the taxpayer dealing with? |
|
| Who has been in
contact with the taxpayer? |
|
| Agents Name: |
|
| Agents Number: |
- |
| Please
provide a brief description of the problem |
|
| Who is
making this referral? |
| *
Your Name: |
|
|
| *
Company Name: |
|
| *
Phone Number |
- |
|
