Authorization Agreement For Electronic Funds Transfer Form Page 2
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1
2INSTRUCTIONS FOR COMPLETING THE EFT AUTHORIZATION AGREEMENT FORM (EFT-1)
General Instructions
Please type or print clearly.
Fax to the California State Controller’s Office at (916) 464-6224
Or mail to the address shown on the front of this form.
Retain a copy for your file before mailing.
Complete Section I
Complete All Applicable Fields
Complete Section II, III or IV:
SECTION II
ACH DEBIT
•
This method allows you to transfer funds to the California State Controller’s Office electronically by debiting an account you
control in a financial institution for the amount that you report to the California State Controller’s Office data collection service.
•
You will have control of the transaction by using a personal security code of your choice.
•
You will receive a reference number for your records that you can use to track the transfer.
•
A REFERENCE NUMBER MUST BE NOTED ON YOUR UNCLAIMED PROPERTY REPORT FORM UFS-1 IN THE UPPER
LEFT-HAND CORNER, OR ON ANY OTHER DOCUMENTS SUBMITTED.
Important: If you have selected the ACH Debit option, you MUST either:
•
attach a voided check
OR
•
a letter, on company letterhead, noting your Bank Transit Routing Number and Bank Account Number
This information will be used only to verify bank account, transit and routing numbers.
Sample Check: The example of a “voided” check, shown below, indicates where to locate the transit routing number for your bank
and your bank account number. Remember to mark the word "void" across the face of the check that is returned with the
authorization agreement.
SECTION III
ACH CREDIT
This method allows you to transfer funds by instructing your ACH participating financial institution to debit your account
and credit the California State Controller's Office Bank account.
EFT Remittance must be in NACHA CCD + format using the Tax Payment Convention (TXP)
and may only be initiated to the California State Controller’s Office
SECTION IV
INTERNATIONAL FUNDS TRANSFER
This method allows you to originate a transaction utilizing the international electronic payment system to transfer funds through federal
reserve banks, whereby the holder debits their own bank account and credits the California State Controller’s Office Bank account.
FOR USE OF THE CALIFORNIA STATE CONTROLLER ‘S OFFICE ONLY
Your enrollment in the California State Controller's EFT program has been approved to commence on:
(Date)
ACH DEBIT
Your method of remittance is:
ACH CREDIT
INTERNATIONAL FUNDS TRANSFER
Unclaimed Property Division By:
SIGNATURE:
TITLE:
DATE:
Rev. 01/2011
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