H&R Block Client Arbitration Opt Out Form

You must complete the information below in order to request to opt out of the arbitration provision in your agreement with H&R Block.

This form is for individual clients. To opt out of the arbitration provisions on behalf of a client who is a business or other entity, please refer to the instructions in the business/entity agreement.

If you would like to receive confirmation of your request to opt out, please complete the optional email address field and check the box at the bottom of the page prior to clicking the "Submit" button.

Thank you for choosing H&R Block as your Tax Partner.


Your Information
Last 4 Digits of Primary SSN*:	- -

Primary First Name*:

Primary Last Name*:

Spouse Information (If Applicable)
Last 4 Digits of Spouse SSN*:	- -

Spouse First Name:
Spouse Last Name:
Your Address and Contact Information Check this box if you do not have a U.S. address.
Street Address 1*:
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Street Address 2:

City*:
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State*:
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Zip*:
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Phone Number:

Email Address*:
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Check this box if you would like an email confirmation of this election (email address required)?

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