Your Information

Please enter information about yourself, in the boxes below. While you are not required to enter any information about yourself, your information would be helpful to us, should we need to follow-up with you in this regard.

Name:

Address:

City:

State: AL AK AB AZ AR BC CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MB MD MA MI MN MS MO MT NE NV NB NH NJ NM NY NL NS NC ND OH OK ON OR PA PE QC RI SK SC SD TN TX UT VT VA WA WV WI WY Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador Nova Scotia North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code:
Enter a zip-code as 5 or 9 numbers, with no dashes, no spaces.

Phone:
Enter a phone number as 10 numbers, with no dashes, no parenthesis, no spaces.

Email:

Referral Information

Please enter information about the person(s) or business(es) you are referring, in the boxes below. Any information you would provide will be helpful.

Name:
*Required

Address:
*Required

City:
*Required

State: AL AK AB AZ AR BC CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MB MD MA MI MN MS MO MT NE NV NB NH NJ NM NY NL NS NC ND OH OK ON OR PA PE QC RI SK SC SD TN TX UT VT VA WA WV WI WY Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland and Labrador Nova Scotia North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code:
Enter a zip-code a 5 or 9 numbers, with no dashes, no spaces.

Phone:
Enter a phone number as 10 numbers, with no dashes, no parenthesis, no spaces.

Email:

Other:
Enter any other identifying information.

Is the person you are referring:

• Self-Employed
• A Business Owner
• An Employer of Other Workers
• An Employee
• Other

Type of Fraud:

• Income Tax or Withholding Tax Fraud
• Sales and Use Tax Fraud
• Cigarette Tax Violations
• Motor Fuel - IFTA Violations
• Motor Fuel - Dyed Diesel Violations
• Other Tax Crimes

Please describe your complaint below. Provide any additional information regarding the business or individual that will help us identify them for purposes of an investigation. Details such as address, business name or home address are helpful.

Submit Your Referral