Form Eft-1 - Authorization Agreement For Electronic Funds Transfers - 2001
ADVERTISEMENT
1FORM
Name of Business
EFT - 1
Maryland Tax Registration Number
Comptroller of Maryland
Tax Type check type(s)
Authorization Agreement for
Federal Employer Identification Number
¨ Withholding
Electronic Funds Transfers
¨ Corporation Income Tax
¨ Sales & Use Tax
Motor Fuel Tax Account Number
¨ Motor Fuel Taxes
Please Print or Type
This section must be completed by all taxpayers
C
O
Primary EFT contact person _____________________________________________________________________
N
T
Address ______________________________________________________________________________________
A
C
____________________________________________________________________________________________
T
City
State
ZIP code
Telephone number
A
Secondary EFT contact person ___________________________________________________________________
P
E
Address ______________________________________________________________________________________
R
S
____________________________________________________________________________________________
O
City
State
ZIP code
Telephone number
N
(S)
____________________________________________________________________________________________
Signature of owner, partner, or officer
Title
Date
Choose only one of the two payment options below
This section to be completed only if you choose the ACH DEBIT OPTION
If ACH Debit is chosen you authorize the Comptroller of Maryland to present the debit entries to your
bank for the tax identified above. Only you can initiate a debit by calling the state’s service bureau and
indicating the amount of tax to be paid by electronic funds transfer.
A
C
Bank name __________________________________________________________________________________
H
Bank address ________________________________________________________________________________
D
B
E
___________________________________________________________________________________________
B
Street
City
State
ZIP Code
I
T
Bank account number __________________________ Bank routing/transfer number _____________________
¨ Checking
¨ Savings
(if known)
___________________________________________________________________________________________
Signature of owner, partner, or officer
Title
Date
This section to be completed only if you choose the ACH CREDIT OPTION
An AUTHORIZED REPRESENTATIVE of your bank must complete and sign this section confirming that
you and your bank are capable of initiating ACH CREDITS in the required CCD + TXP format.
A
C
Bank name ___________________________________________________________________________________
H
C
Bank address _________________________________________________________________________________
C
R
____________________________________________________________________________________________
E
Street
City
State
ZIP Code
D
____________________________________________________________________________________________
I
Printed name of bank representative (optional)
Telephone number
T
____________________________________________________________________________________________
Signature of bank representative
Date
This form must be completed and mailed to:
Electronic Funds Transfer Program
P.O. BOX 1509
COT/RAD 072 Rev. 3/01
Annapolis MD 21404
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Eft-1 - Authorization Agreement For Electronic Funds Transfer (eft) - Hawaii Department Of Taxation
Financial
Form Eft-1 - Authorization Agreement For Electronic Funds Transfer For Real Estate And/or Personal Property Taxes
Financial
Related Categories
Parent category: Financial