Form 90-303 - Application For Direct Deposit Of Iowa Motor Fuel Tax Refunds

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Iowa Department of Revenue
Application for Direct Deposit
of Iowa Motor Fuel Tax Refunds
90-303 (8/14/06)
Please PRINT your company name and address:
This form is for direct deposit of refunds only.
It is not to be used for paying taxes by
_____________________________________
electronic funds transfer.
_____________________________________
Federal Identification Number: ______________________
_____________________________________
Social Security Number: ___________________________
_____________________________________
Fuel Tax Refund Number: __________________________
To be eligible for Direct Deposit, you must provide proof of account ownership. Acceptable proof is a check,
form, report, or other statement generated by the financial institution that has your name, RTN of the financial
institution, and the depositor account number preprinted on it. A deposit slip should not be used to verify the
RTN and account number because it can contain internal routing numbers that are not part of the RTN.
All the information on this form is confidential.
1. Type of Account:
Savings
Checking
2. Check one of the following:
new application
cancellation
change of information
3. Routing Transit Number (RTN):
(You will find these numbers between the symbols 1: and 1: at the bottom left of your check.
This is a 9-digit number.)
4. Your financial institution account number:
Signature required
Authorized Signature: ______________________________________________________ Date: _________________
Direct Deposit Contact Person (please print): _________________________ Telephone Number: _________________
Mailing Address of Contact Person: __________________________________________________________________
File your refund claim as usual.
Your refund will be directly deposited into your account.
Complete this form and return with your Application
for Motor Fuel Tax Refund Permit (form #80-005) to:
Compliance Division, Fuel Tax Unit
Iowa Department of Revenue
PO Box 10456
Des Moines IA 50306-0456
or fax to:
515/281-3756

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