Fee Purchase Program Application

Company Name(*)
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Address(*)
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City(*)
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Zip Code(*)
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Federal Tax ID(*)
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EFIN(*)
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Suite
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State(*)
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Phone(*)
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Fax
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Email(*)
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Owner(s)/Principal Information
Name(*)
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Date of Birth(*)
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Address(*)
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City(*)
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State(*)
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Zip Code(*)
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SSN
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Email(*)
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Owner(s)/Principal Information
Number of Years in Business(*)
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Amount Requested(*)
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2020-21 Funded Bank Products(*)
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Date Funds Needed
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Purpose for advanced funds
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2021-22 Bank Partner(*)
  • - select a option -
  • SANTA BARBARA TAX PRODUCTS GROUP (TPG)
  • REFUND ADVANTAGE
  • REPUBLIC BANK
- select a option -
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Please provide detailed description of planned usage of funds below:
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ATTACH BANK VOLUME REPORT
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We hereby apply for the fee purchase described in this application. We certify that we have made no misrepresentation in this application or in any related documents, that all information is true and complete, and that we did not omit any important information. This application pertains to the applying company potential sale of future fees to the buyer, in this case, uTax Software. Accordingly, Seller and each Guarantor authorizes Buyer and its agents and representatives and any credit reporting agency employed by Buyer to investigate any references given or any other statements of data obtained from or about Seller, any Guarantor or any of Seller’s other principals for the purpose of this application and to order, receive and review credit reports at any time during the application process or subsequent term of any Fee Purchase Agreement.