Form Ccv - Credit Card Payment Voucher - 2005

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Form CCV
Credit Card Payment Voucher
TC00031
9-20-05
Credit Card Account # __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expiration Date __ __ /__ __ __ __
Payment $
Billing Address for the Credit Card
Street
City
State
Zip
Name of Card Holder
Contact Name
Daytime Telephone
Taxpayer Name or Business Name if different from Credit Card Holder
This payment is for:
•
•
Individual Income Tax - Tax Year Ending
MO ___ ___
YR ___ ___
Sale/Use Tax Account # ___ ___ ___ ___ ___ ___ ___ ___ ___
•
Primary SSN ___ ___ ___ - ___ ___ - ___ ___ ___ ___
Self-Assessed Use Tax - Form 850-U
Spouse’s SSN ___ ___ ___ - ___ ___ - ___ ___ ___ ___
SSN ___ ___ ___ - ___ ___ - ___ ___ ___ ___
•
Business Income Tax - Tax Year Ending
MO ___ ___
YR ___ ___
Business EIN ___ ___ - ___ ___ ___ ___ ___ ___ ___
•
Business EIN ___ ___ - ___ ___ ___ ___ ___ ___ ___
Withholding Account # ___ ___ ___ ___ ___ ___ ___ ___ ___
•
•
Permit Based Tax - Tax Period Ending
MO ___ ___
YR ___ ___
____________ Tax Account # ___ ___ ___ ___ ___ ___ ___ ___ ___
Business EIN ___ ___ - ___ ___ ___ ___ ___ ___ ___
Authorized Signature
Date
Check applicable box.
Visa
Discover
MasterCard
CUT HERE
This voucher may be used only for credit card payments.
To make a debit card payment, see instructions below.
You can use your Discover, MasterCard, or VISA card to pay any Idaho taxes you owe.
You may pay the balance due or make an extension payment, pay estimated taxes, or
pay amounts owed for prior years.
To make a payment by credit card, attach this form to the front of the tax return and
mail to the address indicated on the return. If you want to mail your payment separately,
mail this form to:
IDAHO STATE TAX COMMISSION
PO BOX 83784
BOISE ID 83707-3784
To make a debit card payment, visit our secure Web site at tax.idaho.gov and click on
"Electronic Payments." Credit card payments also can be made using the Web site.

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