Please Complete The TaXstar Tax Refund For Down Payment Program Application

All fields marked with a * are required

Business Name*
Street Address*
Mailing Address (if different than above)
Company EIN/SS#
Existing Location or Store #
Contact Name*
Contact Phone*
Contact Fax*
Does your company offer any in-house financing, such as Buy Here, Pay Here?
Yes No
Has your company ever participated in a tax marketing promotion similar to this?
Yes No
By signing below, I acknowledge that I agree with all of the terms stated in the AGREEMENT.
Business Owner or authorized representative: Name:*
Username and Password:
This next section is your username and password to enter the site.
Please enter your Email address for username and remember your password.
Membership Options And Marketting Materials:
Please select the right membership for your organization.
Payment Method
Credit Card* Check or Money Order*
*Your account will be active upon receipt of payment (may take up to 24 hours)
Type of Enrollment
Free Banner Income Tax Preparation
Additional Locations for $239
Additional English Income Tax Preparation Banner for $75
Additional Spanish Income Tax Preparation Banner for $75
Banner: Dont Wait Till Tax Season for $75
Banner: Bring Your W2 And Drive Home Today for $75
Banner: Use Your Tax Refund For Down Payment for $75
Banner: W2-Tax Refund-New Car Today for $75
Banner: W2-Tax Refund-New Car Today for $75
Postcard: Its Income Tax Time for $75
Vehicle Window Sign: Buy me With Your Tax Refund for $10
Table Tent: Free Tax Preparation for $10
Table Tent: How Much is Your Tax Refund for $10
Button: Tax Refund=Car for $10

“Customer acknowledges receipt of goods and/or services in the amount of total shown and agrees to perform the payment obligation:”

I Agree*