Eft-1 Instructions
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1EFT-1 Instructions
Printed Name of Bank Representative: Include bank
Section A - Contact Persons
representative’s telephone number. You must have a bank
All taxpayers must complete this section.
representative confirm that you and your bank are capable
of initiating ACH Credit transactions in the CCD+TXP format.
EFT Contact Persons: Enter the name of the primary contact
You cannot use the ACH Credit option unless your bank
person. The primary contact person should be the individual
can initiate transactions in this format.
responsible for the initiation of the Electronic Funds Transfer
Signature of Owner, Partner or Taxpayer’s Officer:
(EFT) payment. The secondary contact person should be
Authorized signature of owner, partner or officer of taxpayer.
an individual within your company.
Address: Enter the mailing address to be used for
Mailing Address
correspondence regarding Electronic Funds Transfer.
Telephone Number: Enter the telephone number for each
Complete this form and mail to:
EFT contact persons.
State of Connecticut
Department of Revenue Services
Section B - ACH Debit
PO Box 2937
Hartford CT 06104-2937
Complete this section only if you will be making payments
using Connecticut’s State Service Bureau automated
Payroll Companies and Tax Payment
telephone system.
Services
Bank Name: Enter the name of the bank you will be using
for Electronic Funds Transfers.
Companies who will use the ACH Credit option for payments
can submit a completed EFT-1 for each taxpayer, or they
Bank Address: Enter the address of the bank branch you
can submit one EFT-1 that includes the EFT contact persons,
will be using for Electronic Funds Transfers.
bank information, and a separate attached list with the name
Bank Account Number: Enter the account number from
and Connecticut Tax Registration Number of each taxpayer.
which the State of Connecticut will draw debit entries.
Companies using the ACH Debit method must contact the
Type of Account: Check the appropriate box to identify the
EFT Unit for further information on the specific requirements
type of account you will be using for Electronic Funds
necessary for third party ACH Debit transactions.
Transfer (Savings or Checking).
Bank Routing/Transit number: Enter your bank’s nine-digit
EFT Unit Telephone Number
routing/transit number.
860-297-4973
Print Name of Bank Representative:
Include bank
representative’s telephone number. You must have a bank
EFT Unit Fax Number
representative confirm your bank account number and
860-297-4797
routing/transit number.
Signature of Owner, Partner or Taxpayer’s Officer:
EFT Unit E-mail Address
Authorized signature of owner, partner or officer of taxpayer.
ct.eft@po.state.ct.us
This signature authorizes the Connecticut Department of
Revenue Services to present debit entries to your bank for
Forms and Publications
the specified tax.
Forms and publications are available all day, seven days a
week:
Section C - ACH Credit
Internet: Preview and download forms and publications
from the DRS Web site:
Complete this section only if you are choosing the ACH
Credit option.
DRS TAX-FAX: Call 860-297-5698 from the handset
Bank Name: Enter the name of the bank you will be using
attached to your fax machine and select from the menu.
for Electronic Funds Transfers.
Telephone: Call 860-297-4753 (from anywhere), or
Bank Address: Enter the address of the bank branch you
1-800-382-9463 (toll-free within Connecticut) and select
will be using for Electronic Funds Transfers.
Option 2 from a touch-tone phone.
Form EFT-1 BACK (Rev. 02/01)
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