Fax Cover Sheet

Licensed Stores Available!
Own your own Liquid Tax Retail Store

Address:3060 Premiere Prky Duluth, GA 30096
Contact: 888-541-4443
Fax: 877-531-9128

Cover Sheet

This is the fax cover sheet you can fill this sheet online and hit submit and it will send us the information below

From Dealer:
Contact’s Name:
Contact’s Number:
Contact’s E-mail:
Tax Filer’s Name and Driver’s license number if available:

Documents Included:

W2 (how many)

1098 (Mortgage Interest)

Drivers License

Social Secuirty

Interview Sheet

1099 (Self employed)

Other, please explain

Refund Options – see below

	*iRAL* (available January 11th $1,000 - $39 bank fee, net check is $961 and a good history with a bank for RAL product) – AVAILABLE INSTANTLY – Tax Payer must have a minimum refund amount of $2,500 to qualify for the iRAL Advance.
	*Low cost RAL – (24hrs/*$300-$1,000 or up to $1,000 of any return $30.95 + 1.07% of amount requested. Remaining balance = 2 week check)
	*RAL* (24hrs)

(Amount) $300-$1,000………………. (Finance Charge) 1.07 % or $3.21 to $10.70 + $30.95 handling
(Amount) $1,001-$3,799…………… (Finance Charge) 2.5% or $25.00 to $94.98 + $30.95 handling
(Amount) $3,800-$7,500………….. (Finance Charge) $95 max finance charge + $30.95 handling

RAC (2-weeks) $30.95

Automatic Deposit/Checking/Savings:

Bank Name:

Bank Account #:

Routing #:

No up front payment or credit card required with our automatic fee deduction method. Prep Fees not included in above Bank Finance Charges.

Sign:		Date:
Sign:		Date: