Gideon Tax — Honest IRS E-File for Excise & Information Returns

Taxpayer (Part I, lines 1–4)

First name *Last name *

Social Security Number *9 digits, no dashes.This is a joint request (add spouse)This is for a business that is out of operation (line 2)In care of (optional)My address is outside the United StatesStreet address *

Apt / suiteCity *State *ZIP *

My address has changed since I last filed (line 1b)

Give at least one phone number — the IRS requires a home or a work number.

Home phone (line 3)Best time to call at homeWork phone (line 4)

Ext.Best time to call at work

Your request (Part I, lines 5–12)

This request is for which form(s)? *

For most individuals this is Form 1040.

Tax year (Form 1040, 1040-NR, 1040-SS)The year the tax is for, e.g. 2025.

5. Total amount you owe per your return / notice *6. Additional balance due not on line 5

7. Total balance due (lines 5 + 6)

$0

8. Payment you are including with this request

9. Amount owed (line 7 − line 8)

$0

10. Line 9 ÷ 72

$0

Lines 7, 9 and 10 are worked out for you from lines 5, 6 and 8.

11a. Amount you can pay each monthAt least the line 10 amount to e-file. Leave it blank and the IRS uses line 10.12. Day of month for your payment *1–28. No date later than the 28th.

Direct debit (Part I, line 13)

Direct debit is the easiest way to make your payments on time, and it lowers the IRS setup fee.

Withdraw my monthly payment automatically from my checking account13c. I am a low-income taxpayer and cannot make electronic payments through direct debit

Signature

Your 5-digit signature PIN *Any 5 digits you choose except 00000; this signs the form electronically. Nobody chooses it for you.

By signing and submitting this form, I authorize the IRS to contact third parties and to disclose my tax information to third parties in order to process this request and administer the agreement over its duration. I also agree to the terms of this agreement, as provided in the instructions, if it's approved by the IRS. If I chose direct debit, I also give the line 13 authorization above. My PIN (and my spouse's, on a joint request) is my signature.