CREDIT CARD
AUTHORIZATION FORM - Billing Information
(PLEASE PRINT, COMPLETE AND FAX THIS FORM TO (703) 995-0899)
__________________________________does hereby authorize Global
Corporate Services
(Name on Card)
to charge the amount of $350.00 or $ ___________ to its: ( ) MC ( ) Visa ( ) AmEx ( ) DSC
Account No. ________________________Expiration Date __/__ CVV
Code __________
Services Requested:
( ) Filing of 2003 Federal Tax Return
( ) Filing
of State Return (call for fee)
( ) Filing
for previous years (call for quote)
Billing Address
_________________________________________________________
(if mail forwarding address is different, use separate sheet of paper)
City, State, Zip _________________________________________________________
Telephone No. ________________________ Fax No.
________________________
Email Address ___________________________________________
Social Security # _______________________ Date of Birth
____________________
Signed By _______________________________ Title
________________________
Dated ______________
Name of Company _________________________________
Year Incorporated _______________ State of Incorporation
________________
Company Address __________________________________________________
State ________ Zip ___________
( ) I hereby authorize Sandifer Tax
Services to prepare and file my 2003 Federal Tax Return
Dated _____________________Signature
_________________________________
Information For Filing Tax Return
Person Signing Return ________________________________ Title
______________
If you will not be signing the tax return Name and Title of
Officer who will Sign
________________________________________________________________
Mailing Address _______________________________________________________
City, State, Zip ________________________________Country
_________________
Telephone No. ________________________
Fax No._____________________ _
Email Address ________________________________
Date of Birth _______________________SSN
____________________________
Passport Country
__________________________Passport NO. _______________________
Title ________________________________Dated:
________________________________
Principal Activity of Business ________________________________
Have this company ever filed a return before with the IRS? Yes ( ) No (
)
Does the company do business in the State of Delaware? Yes ( ) No (
)
( ) I
understand there are no refunds or cancellations for this service. Global
Corporate Services, Inc. does not provide personal counsel or tax advice
The Tax filing is prepared by a Certified Tax Accounting Service.
Date Bank Account Opened ________________
Starting Capital $________________
Balance as of December 31, 2003 $________________________
Total Receipts for Year 2003 $________________
Complete Expenses Where Applicable
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