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This multi-use form is used to communicate to us how you would like to pay your Tax Liability or what account to place your refund(s) into for Direct Deposit. If you want to set up multiple or partial payments using different accounts or cards, please detail the amounts in the notes section below and submit multiple forms if necessary.

Direct Deposit / Electronic Payment Account Information

Direct Deposit/Electronic Tax Payment(s) Authorization
Select The Option Your Are Requesting
This form is used for Dual Purposes: To provide account info for direct deposit of your refund or to make your tax liability payments electronically.
Please Choose One
Billing Address (Credit Cards & Bank Account Holders)
Billing Address (Credit Cards & Bank Account Holders)
City
State/Province
Zip/Postal

If Paying A Tax Liability By Credit/Debit Card

Credit/Debit Card Type (Processing Fees Apply Check IRS/State Site For Details)
Choose One Card Type To Pay A Fed/State Tax Liability By Card. If Multiple payment types please indiate details in notes section.
Name Of Card Holder
Name Of Card Holder
First
Last
3 or 4 digit code usually on back of card.
By signing this form you authorize Wagner Tax to set up Direct Deposit for your refund or submit your tax liability payment(s) from the bank account or credit/debit card information you provided above. Wagner Tax and its representatives cannot be held liable or responsible for NSF, processing errors, timed-out payment attempt(s), payment website malfunctions, or any other issue where payment does not go through or is returned. This includes Post payment notification of a returned or canceled payment. You also acknowledge that IRS/State agencies can switch a direct deposit to a paper check refund without notice at any time even though it was processed as a direct deposit initially. IRS/State taxing authorities usually provide a confirmation number and notice upon the completion of an electronic payment or direct deposit. There are however times when a payment or deposit is processed but the confirmation page fails to display or is interrupted when this happens there is no way for us to know if the payment was also interrupted. This is rare but full disclosure is necessary.
If you intend to make partial payments or multiple payments with different cards or bank accounts or both--please detail that information here. If you need to submit multiple Payment Forms please do so and be clear with your notes.

This form does not authorize Wagner Tax to use your bank account information for anything other than the direct deposit of your refund.