Income Tax Course Enrollment Form
Required Fields are marked with a red *.
Company:
First Name:	*	(no prefix (ie. Mr., Mrs.) please)
Last Name:	*	(no suffix or title (ie. Jr., CPA) please)
Address:	*
City:	*	(no commas please)
State:	*	Select one AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip Code:	*
Phone Number 1:	*		Extension:
Phone Number 2:			Extension:
Phone Number 3:
E-mail address:	*
Confirm your e-mail address:	*

Are you currently a professional tax preparer?	*	Select one Yes No
Current Tax Preparation Program:	*	Select one I'm new - None AACTS/Vantage Alpine Data Amer. Tax Professionals ATX CCH CPA Software Creative Solutions Crosslink Dalton Drake Dunphy ECKCO Systems ExacTax Federated Full Duplex Systems Greatland H&R Block HowardSoft Jackson Hewitt Lacerte LamSon Laser Librarian Max Micro Vision NCPE Orrtax PCA Tax Pro Series Basic Pro Series Rapid Tax RIA Saber Saxon Softax Stallion Super Forms Tax Act Tax Aid Tax Byte Tax Cut Tax Link Tax Refund Express Tax Series Tax Simple Tax Slayer Tax Star Tax Systems Tax Vision Tax Ware Tax Wise Tax Works Turbo Tax WinTax Xpress
Do you file returns electronically?:	*	Select one Yes No
Do you offer any bank products? (RALs and PERCs):	*	Select one Yes No
How many returns do you expect to prepare?	*
I plan to prepare tax returns from...	*	Select one an Office Building a Retail Space a Residence
I'm likely to purchase tax software...	*	Select one within 1 week within 1 month within 3 months within 1 year not at all
Would you like us to call you?	*	Select one today tomorrow this week don't call me
Ask any questions below:
I understand that by clicking the Enroll Now button below I’ll receive additional information about your income tax course by email and telephone.