Personal Consultation Form
Salutation
Please select
Mr.
Mrs.
Miss
Dr.
Full Legal Name
Home Mailing Address
Suite or Apartment
City
State
Zip Code
Home Telephone
Cellular Telephone
Business Telephone and Extension
Telefax
E-mail Address
Type of Tax Owed
Unfiled Personal Return(s)
Unfiled Business Return(s)
Unpaid Payroll Withholding Taxes
Taxes Alleged by IRS Audit
Other
What Years are Involved
Approximate Amount
Please select
$1,000 to $5,000
$5,000 to $10,000
$10,000 to $25,000
$25,000 to $50,000
$50,000 to $100,000
$100,000 or more
Best Time to Contact
Please Select
Weekday mornings: 9 'til Noon
Weekday afternoons: 1:00 'til 5:00
Weekday evenings at home: 7:00 'til
Saturdays: 10:00 'til 5:00
Please Contact Me By
Please select
Office Telephone
Private Business Telephone
Business Cell Phone
Home Telephone
Personal Cell Phone
Please Select All that Apply
Audited
Levied through my Bank Accounts
Levied through my Payroll Earnings
Have not filed my tax return(s)
Have received notices of levies and
Additional Information/Message
Have you seen our TV commercial?
No
Yes