Form Tr-680 - Promptax-Repaid Sales Tax On Motor Fuel And Diesel Motor Fuel Enrollment Application - Nys Tax Department Page 4

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Page 4 of 4 TR-680 (5/05)
V.
Access code and password
Upon completion of this enrollment, the taxpayer will be issued an access code and password which will be used by ACH
Debit filers to make payments and to log in to the online payment system. ACH Credit and Fedwire filers must include the
access code in their payment addenda records. The taxpayer’s access code and password will be mailed under separate
cover. If you fail to receive the taxpayer’s access code and password, contact the PrompTax Customer Service Center at
1 800 338-0054.
VI. Authorized signature
I have examined the information on this PrompTax Prepaid Sales Tax on Motor Fuel and Diesel Motor Fuel Enrollment
Application and to the best of my knowledge and belief, such application is true, correct and complete. I also hereby state
that I am authorized to act on behalf of the taxpayer with respect to the PrompTax Prepaid Sales Tax on Motor Fuel and
Diesel Motor Fuel Program.
*
Authorized signature:
*
Name of signatory:
(please print)
*
Title:
*
Date:
Please retain a copy of this application for your records.
Need help?
Mail this application to:
PrompTax Internet access:
NYS TAX DEPARTMENT
PROMPTAX - PREPAID SALES (FUEL) TAX
PrompTax fax:
(518) 435-2951
W A HARRIMAN CAMPUS
Telephone assistance is available from 8:00 A.M. to 5:00 P.M.
ALBANY NY 12227
(eastern time), Monday through Friday.
You may also fax the taxpayer’s application (see
PrompTax Customer Service Center:
1 800 338-0054
From areas outside the U.S. and outside Canada: (518) 485-6800
Need help?).

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