Form Tfs-2006 Check Replacement Request And Indemnification Bond (Page 3 of 4) in pdf

Form Tfs-2006 Check Replacement Request And Indemnification Bond Page 3

Re-Issued Checks/Fee Change Request

Fax AND mail the original voided check with this form to:

1-800-278-2056

Date: ________ / _________ / _________

EFIN: ______________________________

Office Name: ___________________________________________________________________

Re-Issue a Check

Taxpayer Social Security Number:

____________ - __________ - ________________

Reason for Re-Issue: _______________________________________________________________________________

________________________________________________________________________________________________

Re-Issue with Fee Changes

Taxpayer Social Security Number:

____________ - _________ - ________________

Tax Preparation Fee:

$ ________________ . _________

Doc Preparation Fee:

$ ________________ . _________

Electronic Filing Fee:

$ ________________ . _________

Service Bureau Fee:

$ ________________ . _________

Transmitter Fee:

$ ________________ . _________

Please direct questions or concerns to customer service:

1-866-491-1040

Tax Preparer’s Signature: ____________________________________________________________________________________

NOTE: VOIDED CHECK MUST ACCOMPANY THIS FORM BEFORE A CHECK RE-ISSUE CAN BE COMPLETED.

Keyed by: _______________

Rev. 05/2007 ERU

Form Tfs-2006 Check Replacement Request And Indemnification Bond Page 3