Supernova Intake Form – Midwest Tax Solutions

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Name

First

Last

Phone

Business Name (if applicable)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Is the above person a decision maker?

Does the decision maker own the property?

If no, please list the owner's information

Product Selection

Notes

Most Recent Electrical Bill (if applicable)

Click or drag a file to this area to upload.

owner's Name (if

Referring Agent

Agent Email

Agent Phone

Agent Code