Pre-Qualify

Are you in an open bankruptcy proceeding?
Yes
No

Have you filed all required Federal Tax Returns?
Yes
No

Have you made all required estimated payments?
Yes
No
N/A

If you are self-employed and have employees, have you submitted all required federal tax deposits?
Yes
No
N/A

Zip code

County

Total Members of Household

Total Members of Household over 65

Total IRS Tax Debt

What is the most recent year for which you are requesting an offer and compromise

Total bank account balances

Value of your home

Mortgage Balance

Equity in Vehicle # 1

Equity in Vehicle # 2

Enter the total amount that you could withdraw from your retirement plans

Other Real Property Equity

Other Asset Equity

Stocks Bonds and Investments

Miscellaneous

Gross Wages

Interest and Dividends

Distribution from Partnerships and Corporations

Net Rental Income

Net Business Income

Child Support Received

Alimony Received

Additional Income

Rent of Mortgage and Utilities

Total Number of Vehicles Owned

Vehicles One Loan or Lease Payment

Vehicles Two Loan or Lease Payment

Vehicle Operating Costs

Public Transportation Costs

Health Insurance Premiums

Life Insurance Premiums

Vehicles One Loan or Lease Payment

Total Yearly Tax Payment

Court Ordered Payments

Dependant Child Care Costs

Briefly Describe How You Incurred Your Tax Debt