Questionnaire
Your Name
*
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
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EFIN Holder Information
Please provide us your EFIN holder information
EFIN# if you have multiple numbers please list them here separately by comma. Ex. 00000, 00000, 00000, etc.
*
Company Name
*
Corporation Type(sole proprietor, partnership, LLC?)
*
EFIN Owner First Name
*
EFIN Owner Last Name
*
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EFIN Holder Title
*
EFIN Issued Address
*
EFIN Issued City, State, Zip
*
IRS Tracking Number (found ion efile summary page)
*
Owner Office Phone Number
*
Owner Home Phone #
*
Owner Cell Phone #
*
Owner fax #
*
Email Address
*
Owner SSN
*
Date of Birth
*
Owner Photo ID State
*
Owner Photo ID # (drivers license)
*
Owner State Photo ID
*
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Owner Photo ID Expiration Date
*
What is your EFIN Registered Under? (EFIN or SSN)
*
Company EFIN (employer identification number)
*
Financial Information
Name of Financial Institution
*
Name of Deposit Account
*
Is this a Checking's or Savings account?
*
Routing Number
*
Account Number
*
Office Information
Office Phone Number
*
Company Name (must be the same above)
*
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Cell Phone Number
*
Fax Number
*
Email Address
*
Office Manager's First Name
*
Office Manager's Last Name
*
Office Manager's e-mail Address
*
Office Manager's SSN
*
Office Manager's Date of Birth
*
# of years at current address
*
# of years e-filing
*
# of years with bank product's
*
# of Office Personnel
*
Where would you like your check mailed if a DD error occurs?
*
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Address Information
Mailing Information
Mail to
*
Mailing Address
*
City, State, Zip
*
Shipping Information
Ship To
*
Shipping Address (NO PO BOX)
*
City, State, Zip
*
Physical Address
*
Physical Address (NO PO BOX)
*
City, State, Zip
*
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Prior Year Stats & Fees (if applicable)
if not, skip
Prior Year Bank (RA, EPS, TPG, etc)
*
Prior Year Efile Volume
*
Prior Year Funded Bank Products
*
Projected Bank Product Volume
*
Prior Year EFIN
*
Add on Fee (Additional Revenue Source)
*
Add-On Fee Net ($0.00-$78)
Service Bureau Add on Fee ($0.00-$99.00)
Fee Deposit Bank Account Type (Business or Personal)
*
Offer Advances/Loan's? (Yes/No)
*
Yes
No
Offer Pre-ack loan's? (Yes/No)
*
Yes
No
Offer Check Disbursement's? (Yes/No)
*
Yes
No
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Offer Card Disbursement's? (Y/N)
*
Yes
No
Which Bank do You Use?
*
Refundo
TPG Bank
Refund Advantage
Republic Bank Security Questions
If required by state and or local laws and regulations, will you possess all license and or certifications for preparing and or facilitating Bank Products/ (Y/N)
Yes
No
If required by your state and or local law enforcement and regulations, will you be in compliance with all posting, written, advertising and or oral disclosure laws related to tax preparation and or Bank Products? Y/N
Yes
No
Is this business minority-owned? Business must be at least 51% owned and managed by U.S. citizens or legal aliens who are Asian, Black, Hispanic, or Native American. Y/N
Yes
No
Is this buisness women-owned? Business must be at leasr 51% woemn owned, managed, and controlled with the buisness owner a U.S. citizen or legal resident alien. Y/N
Yes
No
Is this business disability-owned? Business must be at least 51% owned and managed by U.S. Citizens or legal resident alien's who are disabled. Y/N
Yes
No
Will you require all of your employees, contractors, or affiliates who will offer or discuss Bank Products or who have access to customer information in conjunction with Bank Products to take the online training course required by Republic Bank? Y/N
Yes
No
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Is this business owned by a Disabled Veteran? Business must be 51% owned by one or more service-disabled veteran; and the management and daily business operations are controlled by one or more service- disabled veterans with permanent and sever disability, or the spouse or permanent caregiver of such veteran. Y/N
Yes
No
Have you been the subject of any fines, corrective actions or official orders related to violations of law or consumer compliance regulation's relative to tax preparation or consumer lending? Y/N
Yes
No
What type of office is this? (Home Office, Office Building, or Online)
Home Office
Office Building
Online
Number of all personnel who will be offering or discussing Republic Bank products or who have access to customer information in conjunction with tax preparation services.
Legal Entity Status (LLC, Partnership, Corporation, or Sole Proprietorship)
If you put LLC, is there only one registered member of the LLC or multiple registered owners?
Before using any advertising or marketing of Bank Products, will you first receive approval from Republic Bank? This includes but is not limited to radio or television scripts, videos, newspaper or magazine ads, internet websites or advertisements, social media websites, point-of-sale material, direct mail pieces, emails, newsletters, announcements, power point presentation and /or training manuals. Y/N
Yes
No
Do you use mobile tax software to prepare taxes? Y/N
Yes
No
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Refund Advantage Questions
Security Question: Choose One
What is your mother's maiden name?
What is the name of your first pet?
What high school did you attend?
What is the name of your oldest child?
What is your fathers middle name?
Security Question Answer:
Is this EFIN shared with more than one person? (Y/N)
Yes
No
Has anyone associated with this business ever been assessed preparer penalties , convicted of a criminal offense under federal revenue laws, or been barred from practice?
Yes
No
Refundo Security Questions
If required by state/ local laws and regulations, do you currently possess all licenses and or certification for preparing and or facilitating Bank Products? (you may be asked to provide verification) (Y/N)
Yes
No
If required by your state and or local laws and regulations, are you currently in compliance with all posting, written, and or oral disclosure laws related to tax preparation and or Bank Products? (you maybe asked to provide verification) (Y/N)
Yes
No
Legal Entity Status Filed with the IRS?
Yes
No
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Have you been the subject of any fines, corrective actions or official orders related to violations of law or consumer compliance regualtions relative to tax preperation or comsumer lending? (Y/N)
Yes
No
Before using any advertising or marketing of Bank Products, will you first receive approval from Refundo Bank? This includes but is not limited to radio or television scripts, video, newspaper or magazine ads, internet websites or advertisements, social media websites, point-of-sale materials, direct mail pieces, emails, newsletter's and/or announcement's. (Y/N)
Yes
No
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