Newland's Offer Questionnaire:

(If you are accessing this Questionnaire on the Internet, please print the questionnaire, fill it out and fax the completed form back to us at (703) 330-6586 or mail it to us at Newland & Associates, 9835 Business Way, Manassas, Virginia 20110.

Name:

Address:

Phone:

How much is owed, in total, based on most recent IRS notice?

For what years or periods?

Type of Tax? (1040, 941, Trust Fund Penalty, etc.)

Are you currently paying installments? If so, how much?

Prior Levies (asset seizure)? If "Yes," when?

Wage Garnishments? If "Yes," amount being garnished?

Is there a relative or friend to assist in paying an Offer in Compromise and legal fees? Yes or No.

Are you disputing: (A) the fact that you owe the amount allegedly due; or

(B) stating that you lack the financial means to pay the amount due?

Have you met with a Revenue Officer? Yes or No. If so, his/her name?

Last IRS contact date?

Are you able to pay a retainer and keep the retainer amount current, replenished each month? Yes or No?

Would you like to see a sample fee agreement? Yes or No?

Have you reached a point, for whatever reason, where it appears to you that you have to deal with this problem, accept responsibility and go forward with your life? Yes or No?

End of Questionnaire