Your Company Information

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Company Name:
First Name:
Last Name:
Address:
Address 2:
City:
State:	SELECT Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana International Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Zip:
(xxx-xxx-xxxx)    Phone:
(Used for account activation)    Email:
CTEC#:	(If applicable for CA approved credit.)
Oregon preparer?
Texas preparer?
Current Tax Software:	SELECT A PLUS ALPINE DATA AMTAX AMTAXP ATX/SABER BLOCK CCH PROSYSTEM COLLEGE STUDENT CPA SOFT CREATIVE DRAKE DUNPHY EXACTAX HOWARDSOFT JACKSON HEWITT KIPLINGER TAXCUT LACERTE MICROVISION/ACCT WORLD NONE ORRTAX OTHER PETZ CROSSLINK PRO SERIES RCS TAXSLAYER RIA GOSYSTEM SAXTAX SOFT TAX STALLION TAASC TAXACT TAXLINK/ TAX TRANSLATOR TAXSHOP TAXSIMPLE TAXWARE TAXWORKS UNIVERSAL TAXWISE UNKNOWN XPRESS
Do you file electronically?	SELECT Yes No
Number of 1040 returns you prepare each year?	SELECT None 1         <   100 100     <   500 500     <   1,000 1,000  <  10,000
Number of preparers employed by your firm?	SELECT None 1    <  5 5    <  15 15  <  50 50  <  100
May we send you a free Drake Software evaluation CD?	SELECT Yes No
	I agree to the Terms of Service.

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User Name:
Password:
Confirm Password:
Security Question:	SELECT What is the city where you were born? What is your pet's name? Who was your childhood hero? What was your high school mascot? What is your father’s middle name? What is your mother’s maiden name? What is the name of your favorite sports team?
Answer: