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Excise Tax Payment Application Form

  1. Facility - Business Information

  2. Accountant Information

  3. Does Your Company use an Outside Accountant?*

  4. Does Your Company have an Internal Accountant?*

  5. By checking this box I verify that I am an Authorized to sign legal documents for this Business*

  6. Leave This Blank:

  7. This field is not part of the form submission.