* Required information
Primary contact must be a CPA member of the Fort Worth Chapter.
The undersigned practice unit representative, on behalf of the practice unit, hereby: 1. Certifies that the practice unit is competent to handle matters which have been designated above. Acknowledges that TXCPA Fort Worth is not responsible for actions of prospective clients. 2. Acknowledges that TXCPA Fort Worth makes no representations regarding the number of referrals to be received by the practice unit or the quality of such referral(s). 3. Waives any claim against TXCPA Fort Worth and holds it harmless from and against any loss, claims, suits or liability arising directly or indirectly from referral of prospective clients to the practice unit. 4. Acknowledges that no action is pending which would jeopardize the license of the practice unit in the State of Texas.
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