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Federal Tax Mediation or Business Debt Mediation Application

Business Name:

 1

Contact:

 2

State or Country:

 3

Phone Number:

 4

Email Address:

 5

Type of Business:

 6

Amount Business Debt needing settled:

 7

Amount IRS Debt needing settled:

 8

Is IRS Debt Business or Personal:

 9

IS this an urgent situation:

 10

You must Answer all ten.

  

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