Form 13803 Income Verification Express Service Application and Empl

Department of the Treasury–Internal Revenue Service
Form 13803
September 2006

OMB Number
1545-2032

lncome Verification Express Service (IVES)
Application

Please check the box(es) below that apply to this application.

New

Revised

Add New Location

Official Business Name (required)
(Remains the same when adding
new locations).

Doing Business As (required)
(Remains the same when adding
new locations).

Business ElN/SSN (required)
If your firm is a partnership,
corporation or sole
proprietorship with employees,
provide the employee
identification number. If you do
not have employees, provide
your social security number.
(Remains the same when
adding new locations).

Business Location Address (required)
A new application should be prepared for
each business location. A Post Office Box
will not be accepted.

Billing Address (required, if different
than above)

Fax (required)

Business Telephone Number (required)

Business E-mail address

DUNN and Bradstreet Number
(optional)

Catalog Number 48547A

www.publish.no.irs.gov

Form 13803 (9-2006)

Principal of Your Firm (required) A principal is an officer, owner, business manager or other
person whose responsibility is to administer your company’s participation in the IVES program.
Last name (required)

First Name (required)

SSN (required)

Date of Birth (required)

MI

Primary Contact Name (if different than the principal). A contact must be available on a day to
day basis to answer IRS questions during testing and throughout the processing year.
Last name

First Name

Telephone Number

E-mail address

MI

Responsible Official The Responsible Official is an individual with responsibility for the
operation and IVES users at the business location listed above. A principal listed above may
also be a responsible official.
Last name (required)

First Name (required)

SSN (required)

Date of Birth (required)

MI

Applicant Agreement
The information I have provided on this application is true and correct to the best of my knowledge. I have read
the Internal Revenue Service rules and procedures for participating in the Income Verification Express Service
program and I agree to abide by them and to pay resulting fees timely. I understand that failure to do so will result
in a temporary or permanent exclusion from the program.
Name/title of Principal, partner or owner (type or print)
Signature

Date

Privacy Act Notice:
Our right to ask for information is 5 U.S.C. 301 and the Internal Revenue Code Section 6109 and applicable regulations. The registration
information we are requesting is used to create an account for you, authenticate your identity and for billing purposes. We may disclose the
information to the Department of Justice, to enforce the tax laws, civil and criminal, to cities, states, the District of Columbia and U. S.
commonwealths or possessions to carry out their tax laws. We may give it to other countries under a tax treaty, to federal and state agencies
to enforce federal non-tax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. Your participation in the
Income Verification Express Service (IVES) program is voluntary, however, if you do not provide all or part of the information required to
create your account, you will not be eligible for access to IVES.

Catalog Number 48547A

www.publish.no.irs.gov

Form 13803 (9-2006)