Prospective Client Online Application

Please note that you do not automatically become a client by submitting this form. After receiving your completed form, the LITC will contact you to set up an initial consultation meeting. After the consultation meeting, a clinician will inform you about your status.

Please bring copies of the following items (when applicable) to your first consultation:

  • IRS 30-Day Letter
  • Tax returns you filed for any year in controversy, supporting schedules that are part of the tax returns, W-2's, and other documentation relating to the tax returns
  • Any correspondence to and from the IRS
  • Any other notices recei​ved from the IRS.​
First Name:
Last Name:
Date of Birth:
Select a date from the calendar.
Preferred Telephone:
Alternate Telephone:
Tax years in question:
Amount due to the IRS:
Briefly describe your tax issue:

Please tell us how much income you receive from the following sources. Type "N/A" if it does not apply to you.   :
Type of   IncomeSource of Income
  (Ex: Name of your Employer)
Amount of income/Month
(Ex: $878/month)


Social   Security/Disability

Self-   Employment

Rental   Income

Gambling   Winnings



Child   Support

Alimony Received

Do you own any real estate?:
If Yes, what type and where?:
Do you own a small business?:
If   Yes, how much income do they receive?
  Person 1 income:
  Person 2 income:
  Person 3 income: