ERO Intake Form info@redfiscal.tax Nombre legal / Legal Name. Nombre comercial (DBA) / Trade Name Entidad/Entity Type C Corp S Corp LLC Partnership Sole Propietorship EIN (12-3456789 Date of Incorporation Physical Address City Estado / State AL Alabama AK Alaska AZ Arizona AR Arkansas CA California CO Colorado CT Connecticut DE Delaware FL Florida GA Georgia HI Hawái ID Idaho IL Illinois IN Indiana IA Iowa KS Kansas KY Kentucky LA Louisiana ME Maine MD Maryland MA Massachusetts MI Míchigan MN Minnesota MS Mississippi MO Missouri MT Montana NE Nebraska NV Nevada NH New Hampshire NJ New Jersey NM New Mexico NY Nueva York NC North Carolina ND North Dakota OH Ohio OK Oklahoma OR Oregón PA Pennsylvania RI Rhode Island SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VT Vermont VA Virginia WA Washington WV West Virginia WI Wisconsin WY Wyoming ZIP Phone Website (opcional) Email Contacto Principal / Responsible Official First Name Last Name Phone Email Last 4 SSN Date of Birth (MM/DD/YYYY) ID Type DL State ID Passport Other ID Number Address City Estado / State AL Alabama AK Alaska AZ Arizona AR Arkansas CA California CO Colorado CT Connecticut DE Delaware FL Florida GA Georgia HI Hawái ID Idaho IL Illinois IN Indiana IA Iowa KS Kansas KY Kentucky LA Louisiana ME Maine MD Maryland MA Massachusetts MI Míchigan MN Minnesota MS Mississippi MO Missouri MT Montana NE Nebraska NV Nevada NH New Hampshire NJ New Jersey NM New Mexico NY Nueva York NC North Carolina ND North Dakota OH Ohio OK Oklahoma OR Oregón PA Pennsylvania RI Rhode Island SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VT Vermont VA Virginia WA Washington WV West Virginia WI Wisconsin WY Wyoming ZIP Credenciales IRS / IRS Credentials EFIN EFIN Status PTIN Years of Experience IRS e-Services NO SI Transmission Red Fiscal Service Bureau Propio / Own EFIN) Socios / Propietarios (25%+) / Owners (25%+) • For each owner (up to 3): First Last Ownership % Last 4 SSN DOB (MM/DD/YYYY) ID Type Other DL State ID Passport ID Number Address City Estado / State AL Alabama AK Alaska AZ Arizona AR Arkansas CA California CO Colorado CT Connecticut DE Delaware FL Florida GA Georgia HI Hawái ID Idaho IL Illinois IN Indiana IA Iowa KS Kansas KY Kentucky LA Louisiana ME Maine MD Maryland MA Massachusetts MI Míchigan MN Minnesota MS Mississippi MO Missouri MT Montana NE Nebraska NV Nevada NH New Hampshire NJ New Jersey NM New Mexico NY Nueva York NC North Carolina ND North Dakota OH Ohio OK Oklahoma OR Oregón PA Pennsylvania RI Rhode Island SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VT Vermont VA Virginia WA Washington WV West Virginia WI Wisconsin WY Wyoming ZIP First Last Ownership % Last 4 SSN DOB (MM/DD/YYYY) ID Type Other DL State ID Passport ID Number Address City Estado / State AL Alabama AK Alaska AZ Arizona AR Arkansas CA California CO Colorado CT Connecticut DE Delaware FL Florida GA Georgia HI Hawái ID Idaho IL Illinois IN Indiana IA Iowa KS Kansas KY Kentucky LA Louisiana ME Maine MD Maryland MA Massachusetts MI Míchigan MN Minnesota MS Mississippi MO Missouri MT Montana NE Nebraska NV Nevada NH New Hampshire NJ New Jersey NM New Mexico NY Nueva York NC North Carolina ND North Dakota OH Ohio OK Oklahoma OR Oregón PA Pennsylvania RI Rhode Island SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VT Vermont VA Virginia WA Washington WV West Virginia WI Wisconsin WY Wyoming ZIP First Last Ownership % Last 4 SSN DOB (MM/DD/YYYY) ID Type Other DL State ID Passport ID Number Address City Estado / State AL Alabama AK Alaska AZ Arizona AR Arkansas CA California CO Colorado CT Connecticut DE Delaware FL Florida GA Georgia HI Hawái ID Idaho IL Illinois IN Indiana IA Iowa KS Kansas KY Kentucky LA Louisiana ME Maine MD Maryland MA Massachusetts MI Míchigan MN Minnesota MS Mississippi MO Missouri MT Montana NE Nebraska NV Nevada NH New Hampshire NJ New Jersey NM New Mexico NY Nueva York NC North Carolina ND North Dakota OH Ohio OK Oklahoma OR Oregón PA Pennsylvania RI Rhode Island SC South Carolina SD South Dakota TN Tennessee TX Texas UT Utah VT Vermont VA Virginia WA Washington WV West Virginia WI Wisconsin WY Wyoming ZIP Información Bancaria / Bank Information Bank Partner Other TPG Republic EPS Refund Transfer NO SI Account Type Checking Savings Routing # Account # Documentos Requeridos / Required Documents W-9 firmado / Signed W-9 Carta EIN (CP-575) / EIN Letter ID oficial vigente / Government ID Comprobante de domicilio (últimos 30 días) / Proof of Address (last 30 days) Cheque anulado / Voided Check Política de seguridad (WISP) / Security Policy (WISP) Cumplimiento y Seguridad / Compliance & Security WISP implementado / WISP implemented GLBA Safeguards compliance AML / BSA training actualizado / up to date Verificación de antecedentes / Background checks Controles de acceso físico y digital / Access controls Política de retención y destrucción / Retention policy Consentos y Autorizaciones / Consents & Authorizations Autorizo el cobro de tarifas y tech fees según contrato. / I authorize fees & tech fees per agreement. Autorizo la transmisión electrónica mediante Red Fiscal. / I authorize e-file via Red Fiscal (Service Bureau). Confirmo que toda la información es verdadera y completa. / I confirm all information is true & complete. Acepto los términos y condiciones / I accept the terms & conditions Firmas / Signatures Typed Name Firma ❌ Date Send Volver al inicio
