New York State Department of Taxation and Finance
PrompTax — Petroleum Business Tax
Change of Enrollment Information
Complete this form if any of the taxpayer’s current PrompTax petroleum business tax enrollment data has changed. Please
complete section I, Taxpayer identification as currently enrolled, section VIII, Authorized signature, and only the section(s)
related to the enrollment data to be changed.
Note: Required fields are indicated by an asterisk (*).
I. Taxpayer identification as currently enrolled
You must complete this section before reporting any changes to the taxpayer’s PrompTax petroleum business tax
electronic funds transfer (EFT) enrollment data. You may not use this form to report a change in identification number,
business name, or business address. If you wish to change the taxpayer identification number, name, and/or address, you
must complete and return Form DTF-95, Business Tax Account Update.
*
Taxpayer ID:
DBA company name:
(please print)
*
Legal company name:
Mailing address:
City:
State/Province:
Country:
ZIP code:
II. Change of primary contact information
Please indicate below any change to information concerning the taxpayer’s primary contact person with whom we should
communicate regarding the PrompTax Petroleum Business Tax EFT Program. This individual will receive all material related
to PrompTax participation, including access code, confidential password, forms, and payment advices. Do not designate a
paid preparer as a primary contact person. The taxpayer’s primary contact must be a member of its organization. Complete
only the fields requiring change.
Primary contact person:
(please print)
Mailing address:
City:
State/Province:
Country:
ZIP code:
Telephone number: (
)
Fax number: (
)
Email address:
TR-698 (3/06)