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                                                                                    Department of the Treasury - Internal Revenue Service                                                                          For Official Use Only
        Form 13551                                                                         Application to Participate in the                                                                                       Control number
            (June 2019)                                                                  IRS Acceptance Agent Program  
                                                                                    (Read the instructions carefully before completing this Form)                                                                  OMB Number 1545-1896
Check the type of acceptance agent for                                    Application Type                                                          If you are amending your application, select the reason below
which you are applying                                                              New                                                                    Authorized Representative                                  Business Location
     Acceptance Agent (AA)                                                          Renewal                                                                Acceptance Agent Type
     Certifying Acceptance Agent (CAA)                                              Amended (attach signed explanation)                                    Other
1. Check the box that best describes Organization status                                                                                            Professional Status of Authorized Representative (Individual 
     Financial Institution                                                          Corporation                                                     Listed on Line 5)
     Educational Institution                                                        LLC                                                                    Tax Preparer                        CPA*                   ERO                   Attorney*
     Casino                                                                         Sole Proprietorship                                                    Enrolled Agent* (Enter number)
     Partnership                                                                    Other                                                                  Other                                                                                  (specify)
     Government Agency or Military Organization                                                                                                               *See instructions for proof requirements
2. Legal Name of Business (If an entity, also enter location where organized or created)                                                            3. Business Electronic Filing Identification Number (EFIN)

    and Name and PTIN of Principal Partner or Owner of the Business (See Instructions)                                                              4. Business Employer Identification Number (EIN) (Required)

5. Name and PTIN of Authorized Representative of the Business                                                   6. Date of birth                                7. Social Security Number (SSN) or Individual Taxpayer 
   (first, middle, last, PTIN)                                                                                        (month, day, year)                                  Identification Number (ITIN)

8. Home address (street, city/county, state/country, and ZIP code/                                              9. Check the appropriate box                    10. Have you ever been assessed any preparer penalties, 
   foreign postal code) of individual listed on Line 5                                                                   U.S. Citizen                                     been convicted of a crime, failed to file personal tax 
                                                                                                                                                                          returns, or pay tax liabilities, or been convicted of any 
                                                                                                                         U.S. Resident Alien*                             criminal offense under the U.S. Internal Revenue laws
                                                                                                                         Nonresident Alien**                                       Yes                      No
                                                                                                                *Attach copy of green card 
                                                                                                                **Attach copy of visa if residing                             (Attach an explanation and fingerprint cards for a “Yes” 
                                                                                                                in the U.S.                                                   response.)
11. Doing Business As (DBA) name (complete only if the business is operating under a name which is different than the business name listed on Line 2)

12. Business location address*     Street                                                                       City/County                                     State/Country                      ZIP Code/Foreign Postal Code

*If more than one location, attach continuation sheets for each location and authorized representative(s) with required information.
13. Business telephone number                           (               )                              Fax number  (                   )                               Email
14. Mailing address of the Business if different from the location address on line 12 
Number and street                                                                                               City/County                                     State/Country                      ZIP Code/Foreign Postal Code

15. Does the Business provide tax related services year round                                                                Yes         No             If “No,” provide a brief explanation why

15a. How many Form W-7 applications does the Business plan to submit within a 12-month calendar period
16. Complete the following information for Primary Contact if different than the authorized representative on Line 5 (see instructions)
Primary Contact name (first, middle initial, last)                                                 Title                                                                      Email address
                                                                                                   Phone number              (           )                                    Fax number           (       )
17. Complete the following information for Alternate Contact if different than the individual listed on Line 5                                                            (see instructions)
Alternate Contact name (first, middle initial, last)                                               Title                                                                      Email address
                                                                                                   Phone number              (           )                                    Fax number           (       )
18. Identify the activities performed by you or your organization                                      (tax preparation, University, etc.) as well as the type of customers that you will service (foreign 
     investors, foreign students, etc.) to validate your request for Acceptance Agent status (see instructions)

19. If you would like to be included on the published list of Acceptance Agents located on the IRS website, check here
Under the penalties of Perjury, I declare that I have examined this application and read all accompanying information, and to the best of my knowledge and belief, the information being 
provided is true, correct, and complete. I or my institution and its employees acting on behalf of the institution will comply with all of the provisions of the Revenue Procedure for 
Acceptance Agents and related  publications each year of our participation. Acceptance for participation is not transferable. I understand that if this institution is sold or its organizational 
structure changes, a new application must be filed. I further understand that noncompliance will result in the institution and/or the individuals listed on this application, being suspended 
from participation in the IRS Acceptance Agent Program. I am authorized to make and sign this statement on behalf of the institution.
20. Name and title of Authorized Representative from line 5 (type or print)                                              21. Signature of Authorized Representative                                                         22. Date

 Name and title of Principal, Partner or Owner from line 2 (type or print)                                               Signature of Principal, Partner or Owner                                                           Date

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Your response is voluntary. You are not required to provide the information requested on a form that is  
subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue 
law. Generally, tax returns and return information are confidential, as required by code section 6103. The estimated average time to complete this form is 30 minutes. If you have comments concerning the accuracy of this time estimate or suggestions for 
making this form simpler, we will be happy to hear from you. You can write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, Washington, DC         20224. Do  NOT send this form to this 
address. Instead, enclose it with the magnetic tape and send it to the Service Center to which you submit your tapes or send it to the transmission reception site that received your transmitted returns.
Catalog Number 38262Q                                                                                                www.irs.gov                                                                                   Form 13551 (Rev. 6-2019)



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         Instructions for Form 13551, Application to Participate in the IRS Acceptance Agent Program
General Instructions                                                                                         Line 1. Check the box which best describes the organizational status of the business. If the “Other” box 
Purpose of this Form. All persons who wish to participate in the TIN (Taxpayer Identification Number)        is checked, please insert a brief explanation that best describes the organizational status. Also check 
Acceptance Agent Program must apply by completing this application.                                          the box that best describes the professional status of the applicant. CPAs, Attorneys and Enrolled 
                                                                                                             Agents must attach a copy of an unexpired credential. For example, a valid CPA license, a record from 
What is an Acceptance Agent/Certifying Acceptance Agent. Acceptance agents areindividuals               or   the state bar, or Enrolled Agent enrollment card. If the “Other” box is checked, please insert a brief 
entities (colleges, financial institutions, accounting firms, etc.) that have entered into formal agreements explanation that best describes   the professional status. If you are applying for Acceptance Agent status 
with the IRS that permit them to assist alien individuals and other foreign persons with obtaining TINs.     as a nonprofit organization, attach a copy of your IRS exemption letter. 
The type of duties that you are permitted to perform is based upon your application to become an                     Enter the legal name of the business and the name of the principal, partner or owner of the 
Acceptance Agent (AA) or a Certifying Acceptance Agent (CAA). (See Revenue Procedure 2006-10 for             Line 2. 
additional information.)                                                                                     business along with their PTIN (Preparer Tax Identification Number) if one was issued. A PTIN must be 
                                                                                                             obtained by all enrolled agents, as well as all tax return preparers who are compensated for preparing, 
Who May Apply. Persons eligible to become acceptance agents include a financial institution defined in       or assisting in the preparation of, all or substantially all of any U.S. federal tax return. If your firm is a 
section 265(b)(5) of the Internal Revenue Code (Code) or §1.165-12(c)(1)(iv) of the regulations, a           sole proprietorship, enter the name of the sole proprietor. If the applicant is an entity, provide the state, 
college or university that is an educational organization defined in §1.501(c)(3)-1(d)(3)(i), a federal      including the District of Columbia (or if outside the United States, the country under whose laws the 
agency defined in section 6402(h) of the Code, state and local governments, including agencies               entity was created or organized). If submitting an amended application and the legal name of the 
responsible for vital records, community-based organizations defined in section 501(c)(3) or (d) of the      business is not changing, be sure this entry is identical to the one on your original application. The 
Code, persons that provide assistance to taxpayers in the preparation of their tax returns, and any other    Principal, Partner or Owner of the business is defined below: For entitles with  shares of interests traded 
person or categories of persons that may be authorized by regulations or IRS procedures. An eligible         on a public exchange, or which are registered with the Securities and Exchange Commission, that 
person may be a U.S. person or a foreign person.   Each individual listed as a Principal, Partner or         individual is (a) the “principal” officer if the  business is a corporation, (b) a general “partner”, if a 
Owner of the business,authorized   representative or primary/ alternate contact of the business must         partnership, (c) the “owner” of an entity that is disregarded as separate from its owner, or (d) a grantor, 
have attained the age of 18 as of the date of this application.                                              owner or trustor, if  a trust. For all other entities, it is the person who has a level of control over, or 
When to Apply. New and renewal applications may be submitted year-round. However, to prevent                 entitlement to, the funds or assets in the entity that, as a practical matter, enables the  individual, 
interruption of your business operations, a renewal application should be submitted at least six months      directly or indirectly, to control, manage or direct the entity and the  disposition of its funds and assets 
before the expiration date of your Agreement. It can take up to 120 days (four months) from the time         Line 3. If the business is already an authorized IRS e-file provider, enter the EFIN (Electronic Filing 
that you submit your application to receive your approved Acceptance Agent Agreement from IRS.               Identification Number). An authorized IRS e-file provider is a business (sole proprietorship, partnership, 
How to Apply.All new and renewing persons will be required to complete Form 13551(Application           to   corporation or other entity) that has been accepted into      the IRS e-filing program and has been assigned 
Participate in the IRS Acceptance Agent Program). In addition, there must be an attached fingerprint         an electronic filing identification number.The    EFIN must be the registered number for the location 
card or proof of professional status for each individual listed on Line 5 as an Authorized Representative    specified and EIN. 
(see instructions for fingerprint cards below.) Prior to applying for Acceptance Agent Status, mandatory     Line 4. Enter the IRS issued Employer Identification Number (EIN). Note: All applicants must obtain an 
Acceptance Agent training must be completed and the certificate at the end of the training must be           EIN before submitting this application.   
signed and attached to your Form 13551 when submitting it to IRS. To be valid, the mandatory training               Enter the name, title and PTIN of the authorized representative. This person will be the official 
certificate must be dated within 120 days of the date entered on Line 22. The training is available online   Line 5. 
at www.IRS.gov/itinagents. Original forensic document training certificates for new and renewal              point of contact with the IRS and is responsible for ensuring that all requirements of the Acceptance 
applications submitted by CAAs must also be attached. Note: Your application to become a CAA will            Agent program are followed. They are the only individuals, other than the principal, partner or owner (if 
not be processed if you do not attach a signed mandatory Acceptance Agent training certificate. If           also listed as an authorized representative), who have authority to sign the Certificates of Accuracy. 
applying as a CAA, you must also attach an original forensic document training certificate for each          Each business location is permitted to select up to ten authorized representatives. If you need extra 
Authorized Representative.                                                                                   space to add additional authorized representativesfor      the business location listed on Page 1, or for 
                                                                                                             additional business locations, use the continuation sheet attached to the Form 13551.
Fingerprint Cards. Each individual listed as a responsible party or authorized representative of the                                                                                                       
business must be age 18 or older as of the date of this application. If the authorized representative is an  Line 6. Enter the date of birth of the authorized representative of the business listed on Line 5. This 
Electronic Return Originator (ERO), fingerprint cards are not required. The authorized representative        information should be entered in mm/dd/yyyy format (i.e. April 15, 1950, should be entered as 
must be listed as a Responsible Official on the EFIN to be exempt from the fingerprint requirement. If       04/15/1950).  
the authorized representative is an attorney, CPA or enrolled agent, but not an ERO, evidence of U.S.        Line 7. Enter the Social Security Number or TIN of the authorized representative of the business.          If you 
professional status may be submitted instead of the fingerprint card. If an ERO, include your EFIN on        are a foreign national living outside the U.S. and do not have an SSNor        ITIN, please enter N/A.     
Line 3. The following organizations are exempt from the fingerprinting requirement: a financial institution  Line 8. Enter the complete home address of the authorized representative of the business (street, city/
within the meaning of I.R.C. 265(b)(5) or Treasury Regulations 1.1 65-1 2(c)(1)(iv), a college or            county, state/country and zip code/foreign postal code).  
university that qualifies as an educational organization under Treasury Regulations 1.501 (c)(3)-l (d)(3)
(i), a casino, Federal agencies as defined in IRC 6402(g) an ERO in good standing with the IRS and           Line 9. Check the box which describes the legal status (in the U.S.) of the person entered on line 5. 
foreign nationals without a Social Security Number (SSN) residing outside the United States. (Evidence       Attach a copy of the green card or visa, if you are not a U.S. citizen but are residing in the U.S. 
of your professional status may be obtained by contacting the issuing authority.)                            Line 10. If you answered “Yes” to the suitability question in box 10, please provide an explanation 
Note: Individuals CANNOT take their own fingerprints.The      fingerprint card used for the Acceptance       including dates and circumstances and why you believe that it should not affect your fitness to be an 
Agent Program is unique, and should be obtained by calling the IRS Austin Campus at 1-866-255-0654.          AA/CAA. You will also need to attach fingerprint cards with your application.  
If the authorized  representative of the business changes, the business must submit an amended               Line 11. For the purpose of becoming an acceptance agent, if a “doing business as” (DBA) name is 
application, including a new fingerprint card, if required, for the authorized  representative. Your         used otherthan    the name provided on Line 2, enter that information here and include a brief 
application will not be processed if you do not provide a completed fingerprint card or evidence of          explanation. Use an additional sheet of paper if you need more space. Note: The business will be 
professional status and the original signature of both the authorized representative and the principal,      authorized to operate as an AA/CAA only under the name provided here or on Line 2. 
partner or owner or owner of the business. Faxed copies or photocopies of this application will not be       Line 12. Enter the complete street address, city/county, state/country and zip code/foreign postal code 
accepted.                                                                                                    where the business is located. Note: A post office box (P.O.Box)      will not be accepted as part of the 
When to Update Information. Acceptance Agents must notify the IRS within 30 days of all changes to           address.  
the information they originally submitted on this application, by completing another Form 13551,             Line 13. Enter the telephone number, fax number, and email address of the business. If, in addition to 
checking the “amended” box and attaching a signed statement explaining the changes. This is important        the business telephone, there is another number where you would like to be contacted by IRS, you may 
for several reasons. If information is not up-to-date on our database, you may not receive important IRS     enter that information on this line also, notating that it is the alternative telephone number.   
information or correspondence. Be sure to fully complete the application and only change the 
information that is different from what was originally submitted on Form 13551. Therevised      Form 13551   Line 14.This line should be completed only if you are using a business mailing address that is different 
will not change your address of record for tax purposes, nor will it automatically update information        from the address entered on Line 12. Note:The same mailing address can not be used for  multiple 
associated with your Employer Identification Number (EIN). It can take up to 90 days to process an           business locations. 
amended application.                                                                                         Line 15. Check the “yes” or “no” box to indicate if the business provides tax related services year round 
Where to Apply.Faxed copies or photocopies of this application will not be accepted. Mail Form               (January through December). If the answer is “no”, provide a brief explanation       why the business does 
13551, along with your completed fingerprint card or evidence of professional status if required, forensic   not provide tax related services year round.    
document training certificate (if applying as a CAA), and mandatory Acceptance Agent training                Line 15a. Enter the volume of Forms W-7 that you anticipate filing during a 12 month calendar            period.  
certificate to:                                                                                              Lines 16 and 17. Enter the name of the primary and alternate contact(s) only if different than the 
    Internal Revenue Service                                                                                 authorized representative(s) of the business (individual listed on Line 5 or on the continuation sheet(s) 
    3651 S. IH 35                                                                                            to the application). This is the person that has been authorized by the business to contact the ITIN 
    Stop 6380AUSC                                                                                            Operations to inquire about the status of W-7 applications, but they are not permitted to sign the Form 
    Austin, TX 78741                                                                                         W-7(COA). Also provide the person’s business title, telephone and fax numbers and their email 
Note: Be sure that your application is complete and contains the signatures of both the authorized           address. Each business location may have one primary and one alternate contact.  
representative and principal, partner or owner of the originalbusiness.   (See instructions for Line 20.) To Line 18.You may attach a separate statement to provide a detailed description of the activities 
be valid, the mandatory training certification must be dated within 120 days of the date entered on Line     performed by the business which would validate this request for Acceptance Agent status. For example, 
22.                                                                                                          a tax preparation firm preparing U.S. federal income tax returns for nonresident alien real estate 
Who to Contact for Assistance.  If you need additional assistance in completing this application you         investors who do not qualify for an SSN, would validate this request for Acceptance Agent status. 
can email the ITIN Policy Section at itinprogramoffice@irs.gov where someone will respond to  you.           Line 19. The principal, partner or owner of the business may request to be included on a public list of 
For additional information about Acceptance Agents, refer to Revenue Procedure 2006-10. For                  acceptance agents published by the IRS on its website by checking this box.   
additional information about the Form W-7, see Publication 1915 Understanding Your Individual                Lines 20 and 21. Both the authorized representative and the principal, partner or owner must print and 
Taxpayer Identification Number - ITIN.                                                                       sign their name on this application. By signing the application you are authorizing the Internal Revenue 
How To Complete The Form Check the applicable box to indicate if you are (1) a New applicant, (i.e.,         Service to conduct suitability checks as referenced in the Revenue Procedure. 
the first time that the business is applying for AA/CAA status or your agreement has already expired),       Line 22. Enter the date that this application is signed.  
(2) seeking Renewal of a AA/CAA Agreement that will be expiring or (3) Amending  information on a 
business that is already an AA/CAA (i.e. submitting an application for a new authorized representative;      Pages 3 and 4 – (Continuation sheets)   
changing primary or alternate contacts, etc.). See Revenue Procedure 2006-10 for additional                  Note: Must be attached to a Form 13551 when submitted to IRS.Use             pages 3 and 4 to add additional 
information on Acceptance Agents. For additional information on submitting an amended application,           authorized representatives or a primary and alternate contact for a business location. If the business 
see “When to Update Information” above.                                                                      operates at more than one location, use a separate continuation sheet for each additional office. The 
                                                                                                             continuation pages must also be signed and dated by the Principal, Partner or  Owner of the Business 
                                                                                                             (signature space provided on page 4) and each additional authorized representative, pursuant to the 
                                                                                                             signature requirements for Form 13551, Lines 20 and 21. 

Catalog Number 38262Q                                                                             www.irs.gov                                                                      Form 13551 (Rev. 6-2019)



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                                                                                                                                                                                       Page 3
                                                                Department of the Treasury - Internal Revenue Service
     Form 13551                                                                                                                                               OMB Number  
         (June 2019)                   Continuation Sheet for Additional Authorized Representatives                                                                 1545-1896
                                                                             (see Form 13551 instructions)
Legal Name of the Business (Page 1, Line 2 (and 11, if applicable))                           Business EFIN                                  Business EIN

Business location address      Street                                              City/County                      State/Country            ZIP Code/Foreign Postal Code

Information and Signature of Additional Authorized Representative
Professional Status of          5. Name and PTIN of Authorized Representative of              6. Date of birth                     7. Social Security Number (SSN) or Taxpayer 
Authorized                         the Business (first, middle, last, PTIN)                       (month, day, year)                  Identification Number (ITIN)
Representative (Line 5)
Tax Preparer
                                8. Home address (street, city/county, state/country,          9. Check the appropriate box         10. Have you ever been assessed any preparer 
CPA*                               and ZIP code/foreign postal code) of individual                                                     penalties, been convicted of a crime, failed to 
Attorney*                          listed on Line 5                                               U.S. Citizen                         file personal tax returns, or pay tax liabilities, 
                                                                                                  U.S. Resident Alien*                 or been convicted of any criminal offense 
Enrolled Agent*                                                                                                                        under the U.S. Internal Revenue laws
                                                                                                  Nonresident Alien**
number                                                                                                                                      Yes                     No
                                                                                              *Attach copy of green card 
Other                                                                                         **Attach copy of visa if residing        (Attach an explanation and fingerprint cards 
                                                                                              in the U.S.                              for a “Yes” response.)
    *See instructions for 
     proof requirements
13. Business telephone number          Fax number                        14. Mailing address of the Business if different from the location address on line 12 
     (        )                        (       )                         Number and street               City/County            State/Country       ZIP Code/Foreign Postal Code
Email
Under the penalties of Perjury, I declare that I have examined this application and read all accompanying information, and to the best of my knowledge and belief, the information being 
provided is true, correct, and complete. I or my institution and its employees acting on behalf of the institution will comply with all of the provisions of the Revenue Procedure for 
Acceptance Agents and related publications each year of our participation. 
Acceptance for participation is not transferable. I understand that if this institution is sold or its organizational structure changes, a new application must be filed. I further understand that 
noncompliance will result in the institution and/or the individuals listed on this application, being suspended from participation in the IRS Acceptance  Agent Program. I am authorized to 
make and sign this statement on behalf of the institution.
Name and title of Authorized Representative from line 5 (type or print)                Signature of Authorized Representative                            Date

Information and Signature of Additional Authorized Representative
Professional Status of          5. Name and PTIN of Authorized Representative of              6. Date of birth                     7. Social Security Number (SSN) or Taxpayer 
Authorized                         the Business (first, middle, last, PTIN)                       (month, day, year)                  Identification Number (ITIN)
Representative (Line 5)
Tax Preparer
                                8. Home address (street, city/county, state/country,          9. Check the appropriate box         10. Have you ever been assessed any preparer 
CPA*                               and ZIP code/foreign postal code) of individual                                                     penalties, been convicted of a crime, failed to 
Attorney*                          listed on Line 5                                               U.S. Citizen                         file personal tax returns, or pay tax liabilities, 
                                                                                                  U.S. Resident Alien*                 or been convicted of any criminal offense 
Enrolled Agent*                                                                                                                        under the U.S. Internal Revenue laws
                                                                                                  Nonresident Alien**
number                                                                                                                                      Yes                     No
                                                                                              *Attach copy of green card 
Other                                                                                         **Attach copy of visa if residing        (Attach an explanation and fingerprint cards 
                                                                                              in the U.S.                              for a “Yes” response.)
    *See instructions for 
     proof requirements
13. Business telephone number          Fax number                        14. Mailing address of the Business if different from the location address on line 12 
     (        )                        (       )                         Number and street               City/County            State/Country       ZIP Code/Foreign Postal Code
Email
Under the penalties of Perjury, I declare that I have examined this application and read all accompanying information, and to the best of my knowledge and belief, the information being 
provided is true, correct, and complete. I or my institution and its employees acting on behalf of the institution will comply with all of the provisions of the Revenue Procedure for 
Acceptance Agents and related publications each year of our participation. 
Acceptance for participation is not transferable. I understand that if this institution is sold or its organizational structure changes, a new application must be filed. I further understand that 
noncompliance will result in the institution and/or the individuals listed on this application, being suspended from participation in the IRS Acceptance  Agent Program. I am authorized to 
make and sign this statement on behalf of the institution.
Name and title of Authorized Representative from line 5 (type or print)                Signature of Authorized Representative                            Date

Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Your response is voluntary. You 
are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records 
relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return 
information are confidential, as required by code section 6103. The estimated average time to complete this form is 30 minutes. If you have comments concerning     the accuracy of this 
time estimate or suggestions for making this form simpler, we will be happy to hear from you. You can write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:
W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, Washington, DC 20224. Do NOT send this form to this address. Instead, enclose it with the magnetic tape and send it to the Service 
Center to which you submit your tapes or send it to the transmission reception site that received your transmittedreturns. 

Catalog Number 38262Q                                                                 www.irs.gov                                                        Form 13551 (Rev. 6-2019)



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                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               Page 4
Information and Signature of Additional Authorized Representative
Professional Status of                                                                                                                                               5. Name and PTIN of Authorized Representative of                                                                                                                                                                                                                                                                                                                           6. Date of birth                                                                                                                                                                                               7. Social Security Number (SSN) or Taxpayer 
Authorized                                                                                                                                                                               the Business (first, middle, last, PTIN)                                                                                                                                                                                                                                                                                                                                           (month, day, year)                                                                                                                                                                                Identification Number (ITIN)
Representative (Line 5)
    Tax Preparer
                                                                                                                                                                     8. Home address (street, city/county, state/country,                                                                                                                                                                                                                                                                                                                       9. Check the appropriate box                                                                                                                                                                                   10. Have you ever been assessed any preparer 
    CPA*                                                                                                                                                                                 and ZIP code/foreign postal code) of individual                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          penalties, been convicted of a crime, failed to 
    Attorney*                                                                                                                                                                            listed on Line 5                                                                                                                                                                                                                                                                                                                                                                   U.S. Citizen                                                                                                                                                                                          file personal tax returns, or pay tax liabilities, 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            U.S. Resident Alien*                                                                                                                                                                                  or been convicted of any criminal offense 
    Enrolled Agent*                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               under the U.S. Internal Revenue laws
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Nonresident Alien**
    number                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Yes                                                                                                    No
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                *Attach copy of green card 
    Other                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       **Attach copy of visa if residing                                                                                                                                                                                                 (Attach an explanation and fingerprint cards 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                in the U.S.                                                                                                                                                                                                                       for a “Yes” response.)
    *See instructions for 
    proof requirements
13. Business telephone number                                                                                                                                                                                            Fax number                                                                                                                                                                  14. Mailing address of the Business if different from the location address on line 12 
    (                                                                )                                                                                                                                                   (                                                       )                                                                                                                   Number and street                                                                                                                                                                 City/County                                                                                                                                                        State/Country                                                                                                         ZIP Code/Foreign Postal Code
Email
Under the penalties of Perjury, I declare that I have examined this application and read all accompanying information, and to the best of my knowledge and belief, the information being 
provided is true, correct, and complete. I or my institution and its employees acting on behalf of the institution will comply with all of the provisions of the Revenue Procedure for 
Acceptance Agents and related publications each year of our participation. 
Acceptance for participation is not transferable. I understand that if this institution is sold or its organizational structure changes, a new application must be filed. I further understand that 
noncompliance will result in the institution and/or the individuals listed on this application, being suspended from participation in the IRS Acceptance  Agent Program. I am authorized to 
make and sign this statement on behalf of the institution.
Name and title of Authorized Representative from line 5 (type or print)                                                                                                                                                                                                                                                                                                                                                                                                                              Signature of Authorized Representative                                                                                                                                                                                                                                                                                                                                                               Date

Information and Signature of Additional Authorized Representative
Professional Status of                                                                                                                                               5. Name and PTIN of Authorized Representative of                                                                                                                                                                                                                                                                                                                           6. Date of birth                                                                                                                                                                                               7. Social Security Number (SSN) or Taxpayer 
Authorized                                                                                                                                                                               the Business (first, middle, last, PTIN)                                                                                                                                                                                                                                                                                                                                           (month, day, year)                                                                                                                                                                                Identification Number (ITIN)
Representative (Line 5)
    Tax Preparer
                                                                                                                                                                     8. Home address (street, city/county, state/country,                                                                                                                                                                                                                                                                                                                       9. Check the appropriate box                                                                                                                                                                                   10. Have you ever been assessed any preparer 
    CPA*                                                                                                                                                                                 and ZIP code/foreign postal code) of individual                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          penalties, been convicted of a crime, failed to 
    Attorney*                                                                                                                                                                            listed on Line 5                                                                                                                                                                                                                                                                                                                                                                   U.S. Citizen                                                                                                                                                                                          file personal tax returns, or pay tax liabilities, 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            U.S. Resident Alien*                                                                                                                                                                                  or been convicted of any criminal offense 
    Enrolled Agent*                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               under the U.S. Internal Revenue laws
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Nonresident Alien**
    number                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Yes                                                                                                    No
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                *Attach copy of green card 
    Other                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       **Attach copy of visa if residing                                                                                                                                                                                                 (Attach an explanation and fingerprint cards 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                in the U.S.                                                                                                                                                                                                                       for a “Yes” response.)
    *See instructions for 
    proof requirements
13. Business telephone number                                                                                                                                                                                            Fax number                                                                                                                                                                  14. Mailing address of the Business if different from the location address on line 12 
    (                                                                )                                                                                                                                                   (                                                       )                                                                                                                   Number and street                                                                                                                                                                 City/County                                                                                                                                                        State/Country                                                                                                         ZIP Code/Foreign Postal Code
Email
Under the penalties of Perjury, I declare that I have examined this application and read all accompanying information, and to the best of my knowledge and belief, the information being 
provided is true, correct, and complete. I or my institution and its employees acting on behalf of the institution will comply with all of the provisions of the Revenue Procedure for 
Acceptance Agents and related publications each year of our participation. 
Acceptance for participation is not transferable. I understand that if this institution is sold or its organizational structure changes, a new application must be filed. I further understand that 
noncompliance will result in the institution and/or the individuals listed on this application, being suspended from participation in the IRS Acceptance  Agent Program. I am authorized to 
make and sign this statement on behalf of the institution.
Name and title of Authorized Representative from line 5 (type or print)                                                                                                                                                                                                                                                                                                                                                                                                                              Signature of Authorized Representative                                                                                                                                                                                                                                                                                                                                                               Date

Names and Contact Information for Primary and Alternate Contacts at the business location listed above. (Complete only if primary and  alternate 
contacts for this business location are not already listed as the primary and alternate contacts on page 1, line 16 of the attached  Form 13551.
16. Complete information for primary contact if not listed on attached Form 13551                                                                                                                                                                                                                                                                                                                                                                                                                                                               Complete information for alternate contact if not listed on attached Form 13551
Name (first, middle initial, last) and Title                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Name (first, middle initial, last) and Title

Phone number(                                                                                                                  )                                                                               Fax number (                                                                                                                )                                                                                  Email                                                                                                             Phone number(                                                                                                                         )                                                                                       Fax number (                                                                                                                        )                                       Email
Signature of Principal, Partner or Owner of Business
Under the penalties of Perjury, I declare that I have examined this application and read all accompanying information, and to the best of my knowledge and belief, the information being provided is  true, correct, and 
complete. I or my institution and its employees acting on behalf of the institution will comply with all of the provisions of the Revenue Procedure for Acceptance Agents and related  publications each year of our 
participation.  
Acceptance for participation is not transferable. I understand that if this institution is sold or its organizational structure changes, a new application must be filed. I further understand that noncompliance will result in the 
institution and/or the individuals listed on this application, being suspended from participation in the IRS Acceptance Agent Program. I am authorized  to make and sign this statement on behalf of the institution.
Name and title of Principal, Partner or Owner from line 2 (type or print)                                                                                                                                                                                                                                                                                                                                                                                                                            Signature of Principal, Partner or Owner                                                                                                                                                                                                                                                                                                                                                             Date

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Catalog Number 38262Q                                                                                                                                                                                                                                                                                                                                                                                                                                                         www.irs.gov                                                                                                                                                                                                                                                                                                                                                                                               Form 13551 (Rev. 6-2019)






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