Department of the Treasury - Internal Revenue Service                       OMB Number 
                                                                                                                             1545-2032
Form 13803                   Application to Participate in the Income                                      For Official Use Only 
                                                                                                           Control Number:
(April 2018)              Verification Express Service (IVES) Program 
                             (Please read the instructions carefully before submitting this form)

1. Check the type of application you are submitting:
New              Renewal               Amended                     Add New Location          Cancellation                    Address Change
2.  Check the box that describes your organization status:
Government Agency                      Partnership                 Sole Proprietorship       Corporation                     LLC
Other (Specify)
3. Reason(s) for using the IVES Program: (Select all that apply)
Mortgage Services            Background Check                      Credit Check        Banking Service        Licensing Requirement
Other (Specify)
4. Legal name of business (required)                      5. Employer Identificaton Number (EIN) or Social Security Number (SSN)(required)

6. Doing Business As (DBA) name (Complete only if the business is operating under a different business name listed on line 4)

7. Business location address (required)
Street address                           City                                          State                       Zip Code

Business telephone number (required)      Fax number (required)                        Business e-mail address

8. Billing address required if different from the location address on line 7
Street address                           City                                          State                       Zip Code

9. Complete the following information for the principal, company official, partner, or owner of business.
Company official name (first, middle initial, last)                                    Title                       Telephone number 

Date of Birth (mm/dd/yyyy) (required)    Social Security Number (required)             E-mail address

Home street address                      City                                          State                       Zip Code

10. Primary contact name (required if different than the principal). A contact must be available on a day to day basis to answer IRS 
questions during testing and through the processing year.
Last name                                                          First name                                                         MI

Telephone number (required)                                        E-mail address (required)

11a. Have you been convicted of a felony in the last 10 years? (Attach an explanation for a Yes response)     Yes                     No
11b. Are you current with your individual and business taxes, including any corporation and employment tax 
obligations? (Attach an explanation for a No response)                                                        Yes                     No
12. Estimated annual volume of IVES product requests:
Catalog Number 48547A                                              www.irs.gov                                Form 13803 (Rev. 4-2018)

13. Complete the following information for the responsible official. The responsible official is an individual with responsibility for the 
operation and IVES users at the business location listed above. A principal listed above may also be a responsible official.
Responsible official name (first, middle initial, last)                    Title                                    Telephone number 

Date of Birth (mm/dd/yyyy) (required) Social Security Number (required)    E-mail address

Home street address                   City                                 State                                    Zip Code

14.         By marking this box, you agree to review Publication 4557, Safeguarding Taxpayer Data and abide by the guidelines of the 
publication. In addition, you can only use taxpayer information that you recieve via a Form 4506-T or Form 45-6 T-EZ request 
for the purpose(s) the taxpayer/requestor intended. Failing to complete this section will result in the application being rejected 
and returned. 
Where to fax your application:  Fax your application to your closest IVES location listed below:
                                      IVES location                       Fax number
                                      Austin, Texas                       877-477-9603
                                      Fresno, California                  877-477-0576
                                      Kansas City, Missouri               877-477-9601
                                      Ogden, Utah                         877-477-0580
The IRS conducts a suitability check on the applicant, and on all Principals listed on the application to determine the applicant's 
suitability to be an IVES participant. After an applicant passes the suitability check and the IRS completes processing the application, 
the IRS notifies the applicant of acceptance to participate in the program.
A responsible company official must sign the application agreement indicating understanding of the Privacy Act restrictions relating to 
the use of this service.
Non-Transferable:  Acceptance for participation is not transferable. I understand if this business is sold or its organizational structures 
changes, a new application must be filed. I further understand noncompliance will result in the business and/or the individuals listed on 
this application, being suspended from participation in the IVES program.
Privacy Act Notice: Our right to ask for information is 5 U.S.C 301 and the Internal Revenue Code Section 6109 and applicable 
regulations. The registration information we are requesting is used to create an account for you, authenticate your identity and for billing 
purposes. We may disclose the information to the Department of Justice, to enforce the tax laws, civil and criminal, to cities, states, the 
District of Columbia and U.S. commonwealths or possessions to carry out their tax laws. we may give it to other countries under a tax 
treaty, to federal and state agencies to enforce federal non-tax criminal laws, or to federal law enforcement and intelligence agencies to 
combat terrorism. Your participation in the Income Verification Express Services (IVES) program is voluntary; however, if you do not 
provide all or part of the information required to create your account, you will not be eligible for access to IVES.
Under the penalties of Perjury, I declare I have examined this application and read all accompanying information, and to the best of my 
knowledge and belief, the information being provided is true, correct, and complete. In addition, I have read the Internal Revenue 
Service rules and procedures for participating in the Income Verification Express Service program and I agree to abide by them and to 
pay resulting fees timely. I understand failure to do so will result in a temporary or permanent exclusion from the program.
Name and title of Principal, Partner or Owner (type or print) Signature of Principal, Partner or Owner              Date signed

Catalog Number 48547A                                         www.irs.gov                              Form 13803 (Rev. 4-2018)