First Name

Last Name

Phone *

Email *

Debt Amount $

By entering your client’s (the “Client”) name and contact information and clicking the “Submit” button, you provide your electronic signature and confirm that you have received proper express written consent from the Client for Community Tax LLC and its service providers to contact your client with information and offers at the phone number provided using an automated system, pre-recorded messages, and/or text messages. You also confirm that you will retain the written Client consent for no less than five (5) years and make such consent available to Community Tax LLC upon request. Consent is not required as a condition of purchase. Message and data rates may apply.
I understand that Community Tax has online privacy policies available which I may review at Online and Mobile Application Privacy Policy|Community Tax.

I hereby accept the forgoing terms and affirm the foregoing representations.