TAX RESOLUTION SERVICES AGREEMENT Offered through Liberty Tax Service and Whitewood Tax Solutions. This Agreement is being provided to you as part of the Tax Resolution Services we offer and contains material terms and conditions regarding our services, including an arbitration provision. Please take a few moments to read and complete this form and return it with your business and/or personal tax information. We cannot begin the Tax Resolution Services until you have signed this Agreement. 1. Taxpayer Information (Taxpayer(s) must sign and date this form) Taxpayer s name Taxpayer s Social Security. Spouse s name (if joint tax return) Spouse s SSN (if applicable) Mailing Address City State ZIP code Spouse s mailing address (if different from above) City State ZIP code 2. Terms a) The terms you and yours refer to the person or persons signing below as the Taxpayer or if a joint return, both the Taxpayer and the Spouse. b) The terms we, us, our refer to this Liberty Tax Service franchise. c) The term Whitewood refers to Whitewood Tax Solutions a non-affiliated partner of Liberty Tax Service who provides Tax Resolution Services. d) The term Processor refers to JTH Tax, Inc. e) The term Agreement means this Tax Resolution Services Agreement. f) The term Tax Resolution Service means the process by which Whitewood will attempt to negotiate with both the IRS and state taxing authorities on your behalf to reduce or eliminate your outstanding tax liability and release levies and/or garnishments. 3. Our Services. Liberty, in conjunction with Whitewood, provides Tax Resolution Services. We will develop a resolution plan that is tailored to your unique situation and promise to keep you informed of developments in your case at every stage of the process. Depending on the complexity of your situation, the Tax Resolution Services may take up to several years to complete. You understand and acknowledge that there are no guarantees that the IRS or state taxing authority will accept any offer made in connection with the Tax Resolution Services. 4. Fees for Our Services. You understand that we charge a flat fee for the Tax Resolution Services. The fee for your Tax Resolution Service is $, which is due and payable at the time you sign this Agreement. If we are successful in reducing your tax liability or enrolling you into an IRS and/or state taxing authority relief program, you understand that we charge an Offer In Compromise Acceptance Fee of $. If you elect to accept the relief program, you agree to pay the Offer In Compromise Acceptance Fee. You may pay for the Tax Resolution Services and Offer In Compromise Acceptance Fee by credit card or automatic clearing house ( ACH ) transfer from your personal checking or savings account as indicated below. You may also pay a down payment and pay the remainder of the fees in up to five equal monthly installments. We do not charge you any financing fees should you elect to pay in monthly installments. You understand that a portion of the fees may be shared with Whitewood and the Processor. 5. Payment Schedule: A down payment of $ is due and payable at the time you sign this Agreement and you agree that payment of $ is due on the day of each month (Payment Date) for the next months (maximum of five months) beginning from the date of this Agreement.
6. Payment Method. Please select one of the following options: Electronic Fund Transfers from Checking If you select this option, then you agree to make each installment payment by preauthorized electronic fund transfers from your Personal Checking or Savings Account via ACH debit, pursuant to the terms of the ACH Debit Authorization for Electronic Fund Transfers provisions below. Name of Bank Name Listed on Account or Electronic Fund Transfers from Savings Account City Routing Number State Zip Account Number 1) ACH account orders can only be accepted for United States banks. Orders drawn on accounts with non-us banks will be rejected. 2) Transactions will be processed in the Pacific time zone. Payment by Credit Card If you select this option, then you elect to make each installment payment by providing to us your credit card information and authorizing payment. Credit Card. Expiration Date: CVV2 Number Name Listed on Account Billing Information for this card Street Address City State Zip ACH DEBIT AUTHORIZATION FOR ELECTRONIC FUND TRANSFERS ( Debit Authorization ) By selecting the Electronic Fund Transfers from Checking or Savings Account above, you hereby authorize Liberty Tax Service and the Processor, their agents, successors and assigns, to initiate debit entries to your bank account. You further authorize us and the Processor to debit the same to such account for each payment owing under the Tax Resolution Services Agreement, (or such lesser or greater amount as may be owing). You acknowledge that the origination of electronic transactions to your account must comply with the provisions of U.S. law. Account. For purposes of this Debit Authorization, the term Account means, as applicable based upon your selection above, your Checking Account or Savings Account. NSF Fee. Should your ACH payment be declined by your bank for any reason, your account will be subject to a $25 NSF Fee. You agree to pay such NSF Fee to us. If your payment is declined twice within any 12 month period, we may cancel our Tax Resolution Services. Range of Varying Amounts. Please note that you have the right to receive notice of all transfers varying in amount, and that by signing this Debit Authorization you acknowledge that we have elected to offer you a specified range of amounts for debiting (in lieu of providing the notice of transfers in varying in amount). The range of transfers will be either an amount equal to your installment payments or an amount equal to the outstanding balance (which may be greater than or less than an installment payment based upon your payment history). For any debit outside of this specified range, we will send you a notice. Therefore, by agreeing to the terms of this Debit Authorization you are choosing to only receive notice when a transfer amount exceeds the range specified above.
Dates. You acknowledge that this Debit Authorization is an authorization to initiate a debit entry to your Account on each scheduled Payment Date, or up to 5 days after the scheduled date, as set forth above. Termination. You understand and acknowledge that you may terminate this Debit Authorization by notifying us in such time and manner as to afford us a reasonable opportunity to act on it. Full Force and Effect. This Debit Authorization will remain in full force and effect until we have received written notification from you of its termination in such time and in such manner as to afford us a reasonable opportunity to act on it. Optional Debit Authorization. THE DEBIT AUTHORIZATION IS FOR YOUR CONVENIENCE IN PAYING UNDER THE TAX RESOLUTION SERVICES AGREEMENT. BY SIGNING BELOW ACKNOWLEDGING THIS DEBIT AUTHORIZATION, YOU STATE THAT YOU ARE VOLUNTARILY CHOOSING TO PAY ELECTRONICALLY AND THAT YOU ARE CHOOSING ONLY TO RECEIVE NOTICE OF VARYING TRANSFERS WHEN A TRANSFER EXCEEDS THE RANGE SPECIFIED ABOVE. 7. Your Right to Cancel and Refunds. You may cancel your Tax Resolution Services at any time. Upon notification that you want to cancel your Tax Resolution Services, we will cease working on your file and return to you any papers you provided to us. If you cancel your Tax Resolution Services within three (3) days of signing this Agreement, we will refund to you in full any fees you have paid. If you cancel your Tax Resolution Services after three (3) days of signing this Agreement, you acknowledge and agree that we are entitled to all fees previously billed and paid by you. 8. Acknowledgement of Services and Confidentiality. You acknowledge that we are not a law firm and we do not provide legal advice or services. On occasion, we may use vendors and/or third parties to help us or Whitewood in providing the Tax Resolution Services. Subject to applicable law, we may disclose information to third parties about you: (i) where it is necessary for completing a transaction or providing the Tax Resolution Services; (ii) in order to verify the existence and condition of your tax liabilities or past due accounts; (iii) in order to comply with governmental agencies or court orders; (iv) as otherwise required or permitted by law or government regulation; and (v) and as stated in our privacy policy. 9. ARBITRATION. IT IS IMPORTANT THAT YOU READ THIS ARBITRATION PROVISION CAREFULLY. IT PROVIDES THAT YOU MAY BE REQUIRED TO SETTLE A CLAIM OR DISPUTE THROUGH ARBITRATION, EVEN IF YOU PREFER TO LITIGATE SUCH CLAIMS IN COURT. YOU ARE WAIVING RIGHTS YOU MAY HAVE TO LITIGATE THE CLAIMS IN A COURT OR BEFORE A JURY. YOU ARE WAIVING YOU RIGHT TO PARTICIPATE IN A CLASS ACTION LAWSUIT, CLASS ARBITRATION OR OTHER REPRESENTATIVE ACTION WITH RESPECT TO SUCH CLAIMS. Any claim or dispute ( Claim ) by either you, us, Whitewood or Processor against the other(s) arising from or relating in any way to the Tax Resolution Services, this Agreement, or any transaction conducted with us, Whitewood or Processor or their respective affiliates or assigns will, at the election of either you, us, Whitewood or Processor, be resolved by binding arbitration. This arbitration provision governs all Claims, whether such claims are based on law, constitutional provision, or any other legal theory and whether such Claim seeks as remedies money damages, penalties, injunctions or declaratory or equitable relief. Claims subject to this arbitration provision include Claims regarding the applicability of this provision or the validity of this or any prior Agreement. As used in this arbitration provision, the term Claim is to be given the broadest possible meaning, and included claims that arose in the past or arise in the present or future. If a party elects to arbitrate a Claim, the arbitration will be conducted as an individual action only. This means that even if a demand for class arbitration, class action lawsuit or other representative action, including private attorney general action, is filed, any Claim related to the issues of such lawsuits will be subject to individual arbitration. Claims subject to arbitration also include Claims that are made as counterclaims, cross-claims, third-party claims, interpleaders or otherwise. twithstanding this arbitration provision, if you have a Claim that is within the jurisdiction of the small claims court, you may file your claims there. Any appeal from a decision of a small claims court shall be subject to this arbitration provision. The arbitration, including the selection of the arbiter, shall be administered by the American Arbitration Association ( AAA ), according to the Commercial Arbitration Rules and the Supplemental Procedures for Consumer-Related Disputes. To start an arbitration, you or we must give notice of an election to arbitrate. This notice may be given after a lawsuit has been filed and may be given in papers or motions in the lawsuit. Our notice to you may be provided to you at your last known address or such other address as we may have in our records. All fees and costs are allocated pursuant to the rules of the AAA. The arbiter may award any fees, cost, and expense including attorney s fees, as permitted by the administrator s rules. If you request in writing that we bear your filing, administration and/or arbitration fees and you are acting in good faith, we will pay or reimburse you for such fees. Also, we will pay these fees if applicable law requires us to or if we must bear such fees in order for this arbitration provision to be enforced. We will not ask you to pay or reimburse us for any fees we pay the administrator or arbitrator. We will bear the
expense of our attorneys, experts and witnesses. You will bear the expense of your attorneys, experts and witnesses if we prevail in an arbitration, provided that we will pay your fees if you prevail on a Claim you assert or if we must bear such fees in order for this arbitration provision to be enforced. Also, we will bear any fees if applicable law requires us to. If there is a conflict between the rules and procedures of the administrator and any term in this arbitration provision, the terms of this arbitration provision shall prevail. You or us, including Whitewood or Processor, may bring a summary or expedited motion to compel arbitration of any Claim or to stay the litigation of any Claims pending in any court. The failure to initiate or request arbitration at the beginning of a dispute or claim shall not be construed as a waiver of the right to arbitration. You may obtain a copy of the current rules of the arbitration administrator, including information about arbitration, fees, and instructions for initiating arbitration by contacting the American Arbitration Association, 1633 Broadway, Floor 10, New York, NY 10019. Their website is www.adr.org and telephone number is 800-778-7879. You agree that under this Agreement, you, Whitewood, Processor and us are participating in transactions involving interstate commerce which shall be governed by the provisions of the Federal Arbitration Act, Title 9 of the United States Code ( FAA ) and not by any state law concerning arbitration. The arbiter shall follow applicable substantive law to the extent consistent with the FAA, applicable statutes of limitation and applicable privilege rules, and shall be authorized to award all available remedies, including without limitation, damages, declaratory, injunctive and other equitable relief, and attorney s fees and costs. The arbitrator shall follow rules of procedure and evidence consistent with the FAA, this provision and the administrator s rules. Any court with jurisdiction may enter judgment upon the arbitrator s award. The arbitrator s award will be final and binding, expect for any appeal right under the FAA. Unless applicable law provides otherwise, the appealing party will pay the cost of appeal, regardless of its outcome. However, we will consider in good faith any reasonable written request for us to bear the cost of your appeal. We will pay any fees or expenses we are required by law to pay or in order to make this arbitration provision enforceable. This arbitration provision shall survive termination or suspension, or expiration of this Agreement. If any portion of this arbitration provision is deemed invalid or unenforceable, it shall not invalidate the remaining portions of this arbitration provision or Agreement; provided, however, if the limitations on class actions are struck in a proceeding brought on as a class, representative or private attorney general basis, without impairing the right to appeal such decision, this entire arbitration provision (other than this proviso) shall be null and void in such proceeding. 10. Consent and Governing Law. You certify that all the information contained in this Agreement is true and correct. You understand that no one can guarantee the outcome of the Tax Resolution Services and whether any taxing authority will accept any offers in compromise or payment plans. You understand that the services outlined in Agreement may only involve a portion of the Tax Resolution Services that are required. If we exercise our right to deny offering the Tax Resolution Services herein, we will notify you in writing at the address listed above of such decision and the reason for such decision. You also understand that you shall in all events be fully and directly responsible to pay all fees and charges for the Tax Resolution Services as provided herein. You understand that this Agreement shall be governed by applicable federal laws and the laws of the Commonwealth of Virginia. By signing below, you certify that you ( includes all signers below ) acknowledge receiving a completed copy of the Agreement and further certify that you have read, understand and agree to all the terms and provision set forth in the Agreement, including the Arbitration Provision, which is specifically incorporated herein by reference, and acknowledge receiving a completed copy of the same. Primary Taxpayer Signature Date Spouse Signature Date
LIBERTY TAX SERVICE PRIVACY POLICY FACTS WHAT DOES LIBERTY TAX SERVICE DO WITH YOUR PERSONAL INFORMATION? Why? Companies choose how they share your personal information. Federal law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do. What? The types of personal information we collect and share depend on the product or service you have with us. This information can include: Social Security number and transaction history account balances and payment history wire transfer instructions and account transactions When you are no longer our customer, we continue to share your information as described in this notice. How? All financial companies need to share customers personal information to run their everyday business. In the section below, we list the reasons financial companies can share their customers personal information, the reasons Liberty Tax Services chooses to share, and whether you can limit this sharing. Reasons we can share your personal information Does Liberty Tax Service share? Can you limit this sharing? For our everyday business purposes such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus For our marketing purposes to offer our products and services to you For joint marketing with other financial companies For our affiliates everyday business purposes information about your transactions and experiences For our affiliates everyday business purposes information about your creditworthiness We don't share For our affiliates to market to you We don't share For nonaffiliates to market to you Questions? Call (866) 829-3278 We don't share
Page 2 Who we are Who is providing this notice? Liberty Tax Service What we do How does Liberty Tax Service protect my personal information? How does Liberty Tax Service collect my personal information? To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings. We collect your personal information, for example, when you Enroll for Tax Resolution Services or Tax Preparation Services Give us your income information Provide account information Give us your contact information We also collect your personal information from other companies. Why can t I limit all sharing? Federal law gives you the right to limit only sharing for affiliates everyday business purposes information about your creditworthiness affiliates from using your information to market to you sharing for nonaffiliates to market to you State laws and individual companies may give you additional rights to limit sharing. Definitions Affiliates Financial and non-financial companies related by common ownership or control. We do not have any affiliates naffiliates Joint marketing Financial and non-financial companies not related by common ownership or control. Liberty Tax Service does not share with nonaffiliates so they can market to you. A formal agreement between nonaffiliated financial companies that together market financial products or services to you. We may disclose your information to Whitewood Tax Solutions for them to market to you. Other Important Information N/A