SECURE Online Order Form
CLIENT INFORMATION
First name
Last name
E-mail address
Street Address
City
State
Zip code
Home Telephone number and area code
Work Telephone number and area code
Fax number
Special instructions:
TAX-FILE INFORMATION
Tax software used
TurboTax
Taxcut
Others
Tax file will be transmitted to us as
Tax file is attached
Tax-file sent via E-mail
Fax copy of the ruturn
Mail copy of the return
Upload tax file
PAYMENT INFORMATION
Requested Service
Limited Review - $19.99
Extended Review - $29.99
Business Return Review - $59.99
Credit card type
Visa
Master Card
American Express
Discover
Credit card number
(ex.: 123456789012345)
Expiration date
(Select Month & Year)
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
2001
2002
2003
2004
2005
2006
Name on the card
(if other than client)
I have Read and I accept the terms of the
service agreement
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Copyright © 1998 - 20004 Richard A. Chichakli, P.C. Certified Public Accountants & Information System Auditors
Last modified: February 19, 2007