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I (we) hereby authorize Lee’s Tax City, LLC /dba: 1040TaxStore to initiate ACH transactions to the banking institution and account named as indicated below for the purpose of tax preparation revenue transactions. This authorization is to remain in effect until 1040TaxStore receives written notification of termination or change of account information.

The credit card will be charged for the following circumstances:

For the purpose of paying the initial $99 cost of the program as advertised.
In the event of a "Return ACH" when 1040TaxStore initiates ACH debit for weekly EFiles fees, the credit card will serve as a backup method for payment.

Please Upload Clear Image Of The Front Of Credit Card:

Please Upload Clear Image Of The Back Of Credit Card:

Which Type Of Account:

Checking

Savings

Bank Name:

Please Enter Your Routing Number:

Please Enter Account Number:

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Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

August 20, 2025 2:34 pm EST

ACH Uploaded by 1040TaxStore Admin - brian@1040taxbiz.com IP 204.156.181.56

August 20, 2025 2:41 pm EST

Admin Team - Contact@1040taxstore.com added by 1040TaxStore Admin - brian@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110

August 20, 2025 2:41 pm EST

Admin Team - sales@1040taxbiz.com added by 1040TaxStore Admin - brian@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110

September 4, 2025 11:49 am EST

Admin Team - Contact@1040taxstore.com added by 1040TaxStore Admin - brian@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110

September 4, 2025 11:49 am EST

Admin Team - sales@1040taxbiz.com added by 1040TaxStore Admin - brian@1040taxbiz.com as a CC'd Recipient Ip: 96.72.237.110

September 4, 2025 4:10 pm EST

Admin Team - Contact@1040taxstore.com added by 1040TaxStore Admin - brian@1040taxbiz.com as a CC'd Recipient Ip: 204.156.181.37

September 4, 2025 4:10 pm EST

Admin Team - sales@1040taxbiz.com added by 1040TaxStore Admin - brian@1040taxbiz.com as a CC'd Recipient Ip: 204.156.181.37