Revision Request For Automated Clearing House (Ach) Debit Account Payments Form - Department Of The Treasury
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1New Jersey Electronic Funds Transfer (EFT) Program
Revision Request for Automated Clearing House (ACH) Debit Account Payments
Please follow the steps below to ensure the proper revision of bank account information and to minimize
the possibility of a failed electronic payment.
Visit https:// , complete the identification fields, and click on the Log On button.
Next, click on Maintain Enrollments to update bank account information online. Account information
will be updated immediately. Or
Complete the information below and fax it to the Division of Revenue at (609) 984-6681, or mail it to:
New Jersey Division of Revenue, EFT Unit, PO Box 191, Trenton, NJ 08646-0191. Allow 15-20
business days from the beginning date (see below) to process this request.
Indicate Beginning Date Of New Account (dd/mm/yyyy): ____/____/________
Notes:
Do not send EFT payments for the payment types listed below on/after the date selected above, until notified by the Division of
Revenue. In the interim, e-check payments may be used to make some payments at
Continue to use e-checks until advised by the Division to resume EFT.
Using EFT after the date indicated (above) and before notification from the Division may cause payments to not be properly debited,
resulting in the assessment of penalty and interest charges.
Taxpayer Name: ______________________________ Tax ID #:
-
-
Contact Name: Phone: (____) ____________________ Fax #: (____) ___________________
Street Address: _______________________________ City: ______________State:___ Zip: _________
Account Type:
Checking ____
Savings ____
Select one
Please provide the updated transit/routing and bank account numbers along with the tax(es), fee(s)
and/or payment(s) you wish to address by using the updated account.
New Transit/Routing #:
New Bank Acct. #:
Tax/Fee/Payment
The New Jersey Division of Revenue is hereby authorized to debit entries to the bank account(s)
identified above and the bank is authorized to debit such account(s). The authority is to remain in full
force until EFT payments are no longer required by statute or, if I am a voluntary participant, until the New
Jersey Division of Revenue and I mutually agree to terminate my participation in the EFT program.
Signature:
Title:
Date:
Contact the EFT Unit at (609) 292-9292 Opt 6, or email
for assistance.
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