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                                                                                                                                 05/16
                                ALABAMA            DEPARTMENT OF                 REVENUE

                        Application to Become a Bulk Filer                                                           Clear Form

Name: ___________________________________________________________________________________________
Address: _________________________________________________________________________________________
City: ____________________________________________ State: _______________________ Zip: ________________
Telephone Number: (______)________________ Federal ID Number: ________________________________________
Contact Person:______________________________________ Contact’s Telephone Number: (______)_______________
Contact’s Fax Number: (______)_______________ Contact’s E-Mail Address: __________________________________
Officers:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Type of Organization (i.e. Corporation, Proprietorship, etc.): _________________________________________________

By submitting this application, the above party agrees   to abide by  the laws and    statutes of   Alabama in   the filing of   returns 
on behalf   of Alabama taxpayers. This application  in   no way grants power   of   attorney for this party to   act on behalf of   the  
taxpayer   in matters involving tax disputes. This application does not grant  the  above    party authority to   act as an agent of   
the Department   of Revenue. Any agency    relationship  would  exist between  the   above   party and their  client(s). 

All returns must be timely filed and paid electronically over the Internet using the   My    Alabama Taxes paperless ilingf       and 
payment system. As   a third party bulk filer, you have the option   to either enter each client’s filing information   on-screen   or   
send an electronic file that contains the information for your clients.    Note: One EFT payment cannot cover multiple 
accounts.

                                 ALL  CLIENTS      SHOULD   BE REGISTERED        WITH  THE
                       ALABAMA      DEPARTMENT      OF   REVENUE AND       HAVE  VALID     ACCOUNTS.

If the Department of Revenue determines that your continued business operation presents a risk of loss to your clients, the
Department can suspend your registration and notify your clients of the suspension. The Department can also revoke your
registration and/or assess a penalty if the Department determines that you are not in compliance with the law.

Signature of Officer,
Proprietor, Partner, etc.: _________________________________________________ Date: _______________________

                        Upon completion of this application, please fax to (334) 242-0227.
     If you have any questions concerning this application, please call (334) 242-1584 or 1-866-576-6531.