Write the type of tax form you filed and what year that form was from on the small line directly above Line 1 of the form. For example, if you filed a Form 1040A for tax year 2009 and you are requesting an installment agreement on the amount owed, you will write "1040A" and "2009."
Write the name or names of the tax filers on line 1 exactly as they appear on your Form 1040. If you filed a joint return, you must include both your name and your spouse's name and both Social Security numbers. Add your current address and phone numbers at both work and home on lines 2, 3 and 4. Fill in the name and address for your bank or other financial institution of choice on line 5 and your employer's name and address on line 6.
Enter the total amount you owe for the tax year on line 7. On line 8, enter the amount of the payment you are including with the installment request or made when you sent in your Form 1040, if it was sent separately. On line 9, enter the amount that you are willing to pay each month towards your tax liability. Keep in mind that interest is accruing and the bigger the payments you make, the faster you will pay off your debt and the less interest you will have to pay.
Decide the day you want your payments to due each month. You can choose any day from the first day of the month through the 28th. If you get paid on the same dates each month, such as the first and the fifteenth, choose a payment day that is the day after one of your paydays. If you always get paid on the same day of the week, whether weekly or biweekly, choose a date that will be easy to remember, such as the first of the month. Write the chosen date on line 10.
Enter your bank's routing number and your account number on line 11. This information is not required, but this will allow the IRS to automatically deduct your payments from your account on the day you indicated on line 10. If you would rather send the IRS a check each month, leave line 11 blank.
Sign and date Form 9465. Attach this form to the front of your Form 1040 if you are sending the form immediately when filing your taxes. If you have already filed and are sending Form 9465 by itself, refer to the second page of the form for the correct mailing address, which varies depending on where you live.