Form R-7 - Application For Enrollment As A Virginia Authorized Agent Page 2

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Application for Enrollment as a Virginia Authorized Agent
Purpose. Use Form R-7 to register with The Virginia Department of Taxation as a representative
or Authorized Agent for taxpayer(s). A Virginia Authorized Agent is not required to be an Enrolled
Agent or to first register with the Internal Revenue Service. The Virginia Authorized Agent will
be eligible to correspond with the Department of Taxation by phone or to receive correspondence,
documentation or other written materials that relate to specific tax matters for which a Virginia
Power of Attorney and Declaration of Representative form (PAR 101) has been filed.
Change of Information – Check the box to indicate that this form is being submitted for changes
to name, address, phone number, fax number or e-mail address. Include the Virginia Authorized
Agent number only for change of information purposes.
Last Name – Enter the last name of the individual registering as the Authorized Agent
First Name - Enter the first name of the individual registering as the Authorized Agent
MI - Enter the middle initial of the individual registering as the Authorized Agent
NOTE: Enter your name exactly as it will appear on all Virginia Power of Attorney related
Business Name – Enter the name of the business you represent. If you have no business affiliation,
leave blank.
FEIN – Enter the Federal Employer Identification Number of your business. Leave blank if your
business has no Federal Employer Identification Number.
Business Address – Enter the mailing address of your business where all correspondence should
be sent. If you do not represent a business, enter your personal mailing address. Mailing address
should include street name and number or post office box, city, state and Zip Code.
SSN – Enter your social security number or the last four digits of your social security number.
Federal CAF Number – Enter your Federal Central Authorization File number if applicable. If
you have no CAF number, leave blank.
Signature - You must sign the form. Your request for an Authorized Agent number will not be
processed until we receive a signed R-7 form.
Date – Enter the date that the R-7 form is signed.
Best Daytime Phone Number – Enter the phone number (including the area code) where you can
most easily be reached between 8:00 AM and 5:00 PM Monday thru Friday (EST).
FAX Number – Enter the daytime number where you receive faxed information. If there is no
convenient FAX number, leave blank.
E-mail Address – Enter the E-mail address where you receive business correspondence. If there is
no convenient E-mail address, leave blank.
NOTE: No personalized taxpayer correspondence or TAX information will be sent via e-mail
or FAX. These mediums will only be used for registration purposes and general information.


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