(Rev. February 2017)
Department of the Treasury
Internal Revenue Service
Installment Agreement Request
Information about Form 9465 and its separate instructions is at www.irs.gov/form9465.
If you are filing this form with your tax return, attach it to the front of the return.
See separate instructions.
OMB No. 1545-0074
Tip: If you owe $50,000 or less, you may be able to establish an installment agreement online, even if you have not yet received a bill
for your taxes. Go to IRS.gov to apply to pay online. Caution: Don't file this form ifyou can pay your balance in full within 120 days.
Instead, call 1-800-829-1040. Don't file if your business is still operating and owes employment or unemployment taxes. Instead, call
the telephone number on your most recent notice. If you are in bankruptcy or we have accepted your offer-in-compromise, see
Bankruptcy or offer-in-compromise, in the instructions.
This request is for Form(s) (for example, Form 1040 or Form 941)
and for tax year(s) (for example, 2012 and 2013)
Your first name and initial Last name Your social security number
If a joint return, spouse’s first name and initial Last name Spouse’s social security number
Current address (number and street). If you have a P.O. box and no home delivery, enter your box number. Apt. number
City, town or post office, state, and ZIP code. If a foreign address, also complete the spaces below (see instructions)
Foreign country name
Foreign postal code
If this address is new since you filed your last tax return, check here .................
Name of your business (must be no longer operating)
Employer identification number (EIN)
Your home phone number Best time for us to call
Your work phone number Ext. Best time for us to call
Name of your bank or other financial institution:
City, state, and ZIP code
Your employer’s name:
City, state, and ZIP code
7 Enter the total amount you owe as shown on your tax return(s) (or notice(s)) ........
Enter the amount of any payment you are making with your tax return(s) (or notice(s)). See instructions
9 Subtract line 8 from line 7 and enter the result ..................9
Enter the amount you can pay each month. Make your payments as large as possible to limit interest
and penalty charges. The charges will continue until you pay in full. If no payment amount is listed
on line 10, a payment will be determined for you by dividing the balance due by 72 months
11Divide the amount on line 9 by 72 and enter the result ...............11
• If the amount on line 10 is less than the amount on line 11 and you are unable to increase your payment to the amount on line
11, complete and attach Form 433-F, Collection Information Statement.
• If the amount on line 10 is equal to or greater than the amount on line 11 but the amount you owe is greater than $25,000 but
not more than $50,000, you must complete either line 13 or 14, if you do not wish to complete Form 433-F.
• If the amount on line 9 is greater than $50,000, complete and attach Form 433-F, Collection Information Statement.
12Enter the date you want to make your payment each month. Do not enter a date later than the 28th
If you want to make your payments by direct debit from your checking account, see the instructions and fill in lines 13a and
13b. This is the most convenient way to make your payments and it will ensure that they are made on time.
I authorize the U.S. Treasury and its designated Financial Agent to initiate a monthly ACH debit (electronic withdrawal) entry to the financial
institution account indicated for payments of my Federal taxes owed, and the financial institution to debit the entry to this account. This
authorization is to remain in full force and effect until I notify the U.S. Treasury Financial Agent to terminate the authorization. To revoke
payment, I must contact the U.S. Treasury Financial Agent at 1-800-829-1040 no later than 14 business days prior to the payment (settlement)
date. I also authorize the financial institutions involved in the processing of the electronic payments of taxes to receive confidential information
necessary to answer inquiries and resolve issues related to the payments.
If you want to make your payments by payroll deduction, check this box and attach a completed Form 2159, Payroll Deduction
Your signature Date Spouse’s signature. If a joint return, both must sign. Date
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Cat. No. 14842Y
Form 9465 (Rev. 2-2017)