Business Tax Manager Reporting Agent Authorization for Electronic Filers Form.
Must be completed by taxpayer for every EIN being set up. Form is submitted to the IRS.
C/O govONE Solutions, Inc.
12500 MT. Belford Avenue,
Englewood, CO 80112
Associated Bank is appointed as reporting agent to sign and file federal employment tax returns transmitted electronically and/or submitted on magnetic tape and/or make federal tax deposits (FTDs) for the above taxpayer.
This authorization applies to all federal tax types’, beginning with the tax period indicated and remaining in effect until the taxpayer or designee notifies the IRS that this authorization is terminated or revoked. If the taxpayer is required to file a return electronically or to submit federal tax deposit information electronically, the reporting agent is required to file the return and submit the information electronically for the taxpayer.
This Reporting Agent Authorization revokes all earlier Reporting Agent Authorizations but does not revoke full Powers of Attorney on file with respect to the same tax matters and tax periods covered by this instrument.
I understand that this authorization does not absolve me as the taxpayer of the responsibility to ensure that all tax returns are filed and all taxes are paid on time. I understand and agree that Associated Bank is not a tax advisor or consultant, and is not responsible or liable in connection with the determination or accuracy of any amounts owed, or for any tax-related filings. I authorize the IRS to disclose otherwise confidential tax information to the reporting agent named above, Associated Bank, as necessary to discuss or provide filing or account information relating to employment tax returns filed or to be filed by the agent, Associated Bank and/or to deposits made or to be made by the agent, Associated Bank (including information relating to any penalties resulting from such deposits) and deposit requirements. I certify that I have the authority to authorize the disclosure of otherwise confidential tax information on behalf of the taxpayer.
Signature of Taxpayer (required)
Print Name and Title (if applicable)
Complete and sign this Reporting Agent Authorization for Electronic Filers Form and Enrollment Form. Call 800-354-8103 for assistance in completing these forms.
Return completed and signed forms to any Associated Bank office or mail to:
Associated Bank, N.A.
Green Bay Service Center
Business Tax Manager - MS# 7057
PO Box 19097
Green Bay, WI 54307-9097
For Associated Bank Use Only