First Name

Last Name

Company Name *

Phone *

Email *

Date

Mailing Address

This is where are you year-round or the majority of the time.

Office Country

Address

City

State

Country

Postal Code

Physical Address of Office

No PO Boxes Allowed. If you are a virtual office, leave blank and go to the next step

Office Address

Office City

Office State

Office Postal Code

Shipping Address

No PO boxes allowed. This is where supplies may be shipped. If this is not applicable, leave blank and move to the next step

Shipping Address

Shipping city

Shipping State

Shipping postal code

EFIN Holder Information

Please verify all information is 100% accurate prior to submitting

PTIN Number *

EFIN Number. If you have multiple numbers please separate them by comma. (Ex: 00000, 11111, 22222)

EFIN Owner's First Name

EFIN Owner's Last Name

Business Formation Type

EFIN Issued Street Address

EFIN Issued City

EFIN Issued Postal / Zip Code

IRS TRACKING NUMBER (found on efile summary page)

Owner Cell Phone Number

Owner Email

Owner Office Phone Number

Owner Home Phone Number

EFIN Owner's Date of Birth

EFIN Holder Social Security

What was the bank used as the bank product provider in the prior tax season?

Owner's State Photo ID - Front

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Owner's State Photo ID(back)

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Financial Information

Name of Financial Institution

Primary Use Of Account

ACCOUNT NUMBER

ROUTING NUMBER

Type of Account

Name on the Account

YEARS OF FILING EXPERIENCE

WHAT TYPE OF OFFICE DO YOU HAVE?

WHAT WAS THE BANK USED AS THE BANK PRODUCT PROVIDER IN PRIOR TAX SEASON?

HAS A BANK REFUSED TO RENEW YOUR CONTRACT TO OFFER ANY TAX RELATED BANK PRODUCTS IN THE PAST 5 YEARS?

YEARS AT CURRENT ADDRESS

YEARS DOING BANK PRODUCTS

YEARS DOING E‑FILES

RT VOLUME PROJECTION NEXT YEAR

TOTAL NUMBER OF RETURNS LAST YEAR

# PRINCIPALS IN THE OFFICE

# OFFICE STAFF

PLEASE SELECT A SECURITY QUESTION

PLEASE PROVIDE AN ANSWER TO YOUR SELECTED SECURITY QUESTION

WOULD YOU LIKE TO OFFER CARD DISBURSEMENTS?

WOULD YOU LIKE TO OFFER CHECK DISBURSEMENTS?

DOES THIS EFIN WISH TO OFFER PRE‑ACK ADVANCES?

WHAT IS THE USAGE OF THE LOCATION YOUR OFFICE IS IN?

IS THIS EFIN SHARED IN MULTIPLE LOCATIONS?

ADDRESS WHERE PATHWARD SHOULD MAIL EXCEPTION CHECKS

Which bank are you wishing to partner with for the upcoming tax season?

WOULD YOU LIKE TO OFFER ADVANCES/LOANS?

I certify that the information provided on this application is truthful and accurate. I understand that providing false and misleading information will be the basis for the rejection of my application.

Signature *

Clear

Sell Products *

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