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Online Application
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| Name of Business |
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| Contact Person |
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| Email Address |
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| Type of Business |
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| Total Number of Owners and Employees |
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| Number of Offices |
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| Amount of Coverage Requested |
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| Which additional coverage would you like |
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| Phone Number: |
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| Fax Number: |
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| Street and Number: |
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| City: |
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| State: |
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| Zip: |
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| Address (include any branch location addresses) |
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| Do you currently carry errors and omissions insurance? |
Yes
No
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| Please provide us with details and amounts of any previous claims and their status |
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| Are you an: |
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| Number of years of experience preparing tax returns? |
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| What types of returns does your firm prepare? |
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| Have you and your other supervisors attended a continuing education course in the last year? |
Yes
No
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| Does your firm subscribe to a tax reporter service or similar publications? |
Yes
No
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| Are the reporter updates required reading for all tax preparers in your firm? |
Yes
No
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| Does your firm utilize an outside tax preparation service? |
Yes
No
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| If yes, does the service hold you harmless for liability that may be incurred as a result of their performance? |
Yes
No
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| Does your firm utilize an in-house computer with a tax preparation software package? |
Yes
No
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| If no, please briefly explain how tax forms are prepared. |
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| Is there a review of all tax preparation by a supervisor, who is not involved in that preparation, prior to releasing the return? |
Yes
No
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| Have you or any member of your firm been subject to a tax preparer's fine(s) or penalty levied by the Internal Revenue Service, or to disciplinary action by any state board of accountancy, AICPA, or state society? |
Yes
No
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| If yes, please list the dates, dollaramounts, and other specifics. |
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| Has your firm had a peer review under the sponsorship of the AICPA, a state society, or any other professional association, in the last three years? |
Yes
No
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| If yes, please list the dates, dollar amounts, and other specifics. |
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| Have you or any member of the applicant firm ever had a claim or suit made against you for tax preparation or bookkeeping activities? |
Yes
No
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| If yes, please provide us with the details. |
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| Has any member of the applicant firm refused, suspended, or revoked? |
Yes
No
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| If yes, please provide us with the details. |
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