New York State Department of Taxation and Finance
PrompTax — Prepaid Sales Tax on Motor Fuel and Diesel Motor Fuel
Change of Enrollment Information
Complete this form if any of the taxpayer’s current PrompTax prepaid sales tax on motor fuel and diesel motor fuel
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 prepaid sales tax on motor
fuel and diesel motor fuel 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 Prepaid Sales Tax on Motor Fuel and Diesel Motor Fuel 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-697 (3/06)