1025 Form 14310-A (PDF)

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f14310a.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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Referred to growth group territory Date of referral

Potential partner's organizational name

Name of primary contact Telephone number Email

Mailing address

Street City State Zip Code

Name of relationship manager providing the referral Team number Telephone number

Territory manager's name Telephone number

Name of referring partner (if applicable)

Primary contact name Telephone number

Pre-contact analysis conducted Yes No

Briefly describe how you came across this potential partner and a description of their organization

Click the button to email the completed form to the appropriate growth team and cc your territory manager

Growth Group Use Only

Received by SEID Received date

Follow Up action notes

Form 14310-A (Rev. 10-2025) Catalog Number 74975W publish.no.irs.gov Department of the Treasury - Internal Revenue Service