Fillable Form Sfn 22006 - Sales Tax Webfile Application printable pdf download

SALES TAX WEBFILE APPLICATION

For office use only:

OFFICE OF STATE TAX COMMISSIONER

Approved ______________

SFN 22006

Business name: ____________________________________________________

Contact name: _____________________________________________________

Please check appropriate box:

Mailing Address:____________________________________________________

New registration

City, State, Zip: _____________________________________________________

Change contact name/address

Permit #: __________________

Telephone: (

) ______________________

Change payment method

E-mail address: ____________________________________________________

Change bank account

By signing below, I understand I have applied for permission to file Sales Tax returns via WebFile, and agree to follow the

guidelines set forth in the WebFile handbook. I also understand once I have been approved to file electronically, I will not

receive a paper return from the North Dakota Office of State Tax Commissioner (STATE), and will be required to file electroni-

cally and use the same form of payment each period. The authorization to participate is in effect until it is terminated by either

party. I have selected a payment option below, and have provided the necessary information.

Authorized signature: ________________________________________________

Date: ________________

Print name: ___________________________________________

Title: ______________________________

Webfile is recommended, but is not required

WebFile Payment Method (select one)

Paper check - taxpayer submits check with voucher

ACH Debit - taxpayer initiates through the Office of State Tax Commissioner

I authorize the STATE, or its authorized agent, to initiate debit entries to the following account. I understand this authority will

only apply to webfiled Sales Tax returns. It will remain in effect until changed or terminated by written notification to the STATE

at least 30 days prior to the requested date.

ACH Debit Bank Information: Attach a copy of a voided check.

(An example of a check with markings is on the back of this sheet for your reference.)

Bank Name: _____________________________________________

Telephone number: (

) _________________

Routing number (requires 9 digits)

Type of account:

Savings

Checking

__ __ __ __ __ __ __ __ __

Bank account number (not to exceed 17 digits)

__ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Authorized signature: ________________________________________________

Date: ________________

Print name: ___________________________________________

Title: ______________________________

ACH Credit - taxpayer initiates through own bank

I hereby request authorization from the STATE to initiate Automated Clearing House credit transactions to the STATE’s bank

account. I understand these must be in the NACHA standards format using the TXP convention to facilitate the proper posting

of the credit. I also understand this authority will only apply to webfiled Sales Tax returns. It will remain in effect until changed or

terminated by written notification to the STATE at least 30 days prior to the requested date.

Authorized signature: ________________________________________________

Date: ________________

Print name: ___________________________________________

Title: ______________________________

(Don't forget to sign the application before submitting it to the ND Office of State Tax Commissioner)

Form Sfn 22006 - Sales Tax Webfile Application

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