A. S. Khoury & Associates, P.C.
Chartered Public Accountants & Consultants

Income Tax Return Request Form

This form will be sent immediately to our headquarters, and will be attended to promptly. We are always working to facilitate our client affairs, and hope you will join our growing number of satisfied clients.

Personal Information for American and/or Permanent Resident Living in the U.S.

First Name:

Last Name:

Firm Name:

Your Title:

Street Address:

City:

State:

Zip Code:

Home Phone #:

Business Phone #:

Fax #:

E-Mail Address:

Please tell us in your own words what your expectations are, and what you have in mind in terms of preparing your income tax return. Feel free to include any questions you might have for us.

PLEASE MAKE SURE ALL INFORMATION IS CORRECT BEFORE YOU CLICK THE "SUBMIT BUTTON". IF YOU THINK YOU NEED TO CHANGE SOME INFO ON ANY FIELD, SIMPLY GO TO THAT FIELD AND DELETE THE INFO. ONCE YOU ARE SURE, CLICK ONLY ONCE ON THE SUBMIT BUTTON. DUE TO HIGH TRANSACTION VOLUME, YOUR INFORMATION MAY TAKE A MINUTE TO PROCESS.

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All contents Copyright 2000-2001
A.S. Khoury & Associates, P.C.
7023 Little River Turnpike, Suite 340
Annandale, VA 22003

Tel #: 877-941-7411 Toll Free
Main Tel #: 703-941-7411
Fax #: 703-941-0120 or
Fax #: 703-941-5488
E-mail: askgbs@yahoo.com

This document last modified: 6/21/07