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This application is
Illinois Department of Revenue New Revised
IL-8633-I Application to File Illinois Individual Income Tax Returns Electronically
for Software Developers
Mail to: Electronic Commerce Division, Illinois Department of Revenue, P.O. Box 19479, Springfield, IL 62794-9479
An assigned Internal Revenue Service (IRS) Electronic Filer Identification number (EFIN) and an IRS Electronic Transmitter
Identification number (ETIN) are required to complete Form IL-8633-I. We will not process Form IL-8633-I without both the
IRS identification numbers. If any of the information you provide below changes after you submit your Form IL-8633-I, you must
complete and submit a "Revised" Form IL-8633-I to update your information.
Step 1: Complete the following information
1 _________________________________________________ 6 __________________________________________________
Legal name of business (as shown on tax return) Federal employer identification number (FEIN) or Social Security number (SSN)
2 _________________________________________________ 7 __________________________________________________
Doing business as (dba) name (if different than Line 1) Primary contact representative
3 _________________________________________________ __________________________________________________Ext.:
Business street address Daytime phone - include area code FAX number and area code
_________________________________________________ 8 __________________________________________________
City State ZIP Alternate contact representative
4 _________________________________________________ __________________________________________________Ext.:
Mailing address (if different than above) Daytime phone - include area code FAX number and area code
_________________________________________________
City State ZIP
5 _________________________________________________
Business e-mail address
Step 2: Provide your EFIN and ETIN
9 EFIN: ___ ___ ___ ___ ___ ___ ETIN: ___ ___ ___ ___ ___
Step 3: Sign below - Signature is required for both new and revised applications
Under the penalties of perjury, I state that I have examined this form and, to the best of my knowledge it is true, correct, and complete.
I state that this business will comply with all the provisions of the program, that acceptance for participation is not transferable, and that
noncompliance will void participation in the program. I am authorized to make and sign this statement on behalf of the business.
___________________________________________________ ____________________________________________________
Name and title of official or principal owner of the business (Please print.) SSN of an official or principal owner of the business
___________________________________________________ ____________________________________________________
Signature of the official or principal owner of the business Date
This form is authorized as outlined by the Illinois Income Tax Act. Disclosure of this information is required of those taxpayers to whom this form applies.
IL-8633-I (R-12/12) Failure to provide this information when required could result in a penalty. This form has been approved by the Forms Management Center. IL-492-2742
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