Tax Preparation Fees Payment Agreement

Full Name (as it appears on card & bank account)(required)

Email(required)

Payment Schedule:(required) Pay Now (required if return has a balance due or delayed refund due to injured spouse)

Pay Once Refund Received ($1 will be charged on card immediately to ensure validity)

Credit Card Type Visa Mastercard Discover American Express

Credit Card Number (must be linked to bank account for refund)(required)

Expiration Date (MM/YY)(required)

CVW/Security Code(required)

Billing ZIP Code(required)

Billing Address(required)

Routing Number(required)

Bank Account Number(required)

Confirm Bank Account Number(required)

There is a new MD Electronic Filing Requirement to provide MD License or ID (required) Driver's License

State Issued Identification Number

I do not have either

Driver's License Number (OR State Issued Identification Number)

State of Issue(required)

Issue Date

Expiration Date (If your State Issued Identification Number does not expire leave blank)

Spouse (Please select one if filing status on MD return is married filing joint) Driver's License

State Issued Identification Number

I do not have either

Driver's License Number (OR State Issued Identification Number)

State of Issue

Issue Date

Expiration Date (If your State Issued Identification Number does not expire leave blank)

I understand the submission of this form constitutes agreement to service terms as outlined in documentation provided separately. I understand that I shall be charged the agreed upon fees on the scheduled pay date. I understand that there is a $5 processing fee on all invoices processed. Invoices that will be paid on the scheduled refund date will be imposed an additional $25 fee. I understand by pressing the submit button I agree to the payment options as outlined above and in accordance with the invoice received for said services. I understand that my credit card will be charged $1 immediately if I choose to pay my fees on my scheduled refund date to ensure the information I provided is valid.(required)

Submit