WISP FORM

Notes before using form.

The form will take 10-20 minutes to complete.
Selecting “Fail” does not automatically disqualify the WISP itself from being compliant.
The information needs to be accurate & truthful.
After the form is completed, a WISP specialist will use the information provided and generate an IRS compliant WISP and deliver to you via email.
It takes us 1-3 business days to take this information and create a WISP.
You can only submit this form once, have all information accurate at time of submission.
Call your tech person before starting
You can hold on to this link and do the form later.

Step 1 of 7

Your Company Name *

Include LLC, PA, etc. If a DBA, put the DBA name.

Company Owner Name *

First

Last

Email *

Phone *

Name of Person or Company Doing This Audit *

I attest under the penalties of perjury and potential loss of license that all answers on the document will be correct and accurate as of the time of creating this document. *

Inventory

List all devices that contain taxpayer data. This includes not only social security numbers and banking information, but even email addresses. The form supports up to 5 devices, if you use less than 5, just leave the extras blank. If the devices are in the same location, you need to re-type the same address in each device location address box.

Device 1 Name *

Device name for audit. Primary computer or server.

Device 1 Location Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Use 2 letter state code (FL vs Florida)

Device 2

List information about the 2nd device that holds taxpayer data. If you do not have a second device, then leave this blank and proceed to next page.

Device 2 Name

Device 2 name for audit. Leave blank if there isn't another device.

Device 2 Location Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Use 2 letter state code (FL vs Florida)

877-572-6989

Inventory

Device 2

Device 3

Device 4

Device 5

Device 6

Device 7

Device 8

Device 9

IRS - Taxes Security Together: Security Six

IRS Publication 4557: Safeguarding Taxpayer Data

Secure Wireless Networks

WISP Requirements

IT Company Contact Information