Form Tr-680 - Promptax-Repaid Sales Tax On Motor Fuel And Diesel Motor Fuel Enrollment Application - Nys Tax Department Page 2

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Page 2 of 4 TR-680 (5/05)
Please indicate a secondary contact person.
Secondary contact person:
(please print)
Mailing address:
City:
State/Province:
Country:
ZIP code:
Telephone number: (
)
Fax number: (
)
Email address:
If the taxpayer is applying for voluntary participation in the PrompTax Prepaid Sales Tax on Motor Fuel and Diesel Motor Fuel
Program, check the box below.
The taxpayer is applying for voluntary participation in the PrompTax Prepaid Sales Tax on Motor Fuel and Diesel
Motor Fuel Program. The taxpayer is not mandated to participate in such program. The taxpayer wishes to volunteer.
II. Designation of paid preparer
If the taxpayer wishes to designate a paid preparer to act as its agent for making the required Prepaid Sales Tax on Motor
Fuel and Diesel Motor Fuel payments, complete this section. You must also include a signed and notarized Form POA-1,
Power of Attorney. You may download forms from the Tax Department Web site at
Paid preparer name:
(please print)
Mailing address:
City:
State/Province:
Country:
ZIP code:
Telephone number: (
)
Fax number: (
)
Email address:

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