7004 Order Form

Application for Automatic Extension of Time To File Certain Business Income Tax, Information and Other Returns

Go to www.irs.gov/Form7004 for instructions and the latest information.

Personal Information
Name(Required)
First Last
Identifying number(Required)
Email(Required)
Phone(Required)
State(Required)
Address(Required)
Street Address City ZIP Code
Part I: Automatic Extension for Certain Business Income Tax, Information, and Other Returns.
1. Type of Tax Extension(Required)
Hidden
1b. This application is for
Part II: All Filers Must Complete This Part
2. If the organization is a foreign corporation that does not have an office or place of business in the United States,
- Check here
3. If the organization is a corporation and is the common parent of a group that intends to file a consolidated return,
- Check here

Enter below the name, address and employer identification number (EIN) for each member covered by this application.

Name	Address	EIN

4. If the organization is a corporation or partnership that qualifies under Regulations section 1.6081-5,
- Check here
5a. For what calendar year is this application for?
or tax year begining
and ending
5b. Short tax year. If this tax year is less than 12 months, check the reason:
- Initial return
- Final return
- Change in accounting period
- Consolidated return to be filed
6. Tentative total tax
7. Total payments and credits
8. Balance Due
Email
This field is for validation purposes and should be left unchanged.