Form 4572 - Electronic Filing Trading Partner Agreement (Tpa)

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Department Use Only
Missouri Department of Revenue
Form
(MM/DD/YY)
Electronic Filing Trading Partner Agreement (TPA)
4572
Missouri Tax I.D.
Federal Employer
Number
I.D. Number
For ACH File Specifications you can access the Department’s website at
to download the
Electronic File Specifications and Record Layouts for EFT of Business Tax Return and Payment Using ACH Credit with TXP Addendum
(Form
4585).
This TPA between the Missouri Department of Revenue (Department) and _______________________________________________
d/b/a _______________________________________________, (Taxpayer) is entered into pursuant to authority given in the Revised
Statutes of Missouri (RSMo) and the Code of State Regulations (CSR).
The Department and the Taxpayer agree as follows:
1. The Department authorizes the Taxpayer to file Missouri withholding payments and returns, corporate income tax payments, or sales
and use tax payments required to be filed with the Department, pursuant to
Chapters 143
and 144, RSMo, by means of electronic
transmission.
2. Each tax report or return filed in electronic form pursuant to this TPA shall for all purposes be considered a “writing,” “signed by the
Taxpayer” and an “original” report or return.
3. The signature of the Taxpayer or the Taxpayer’s authorized agent (Agent) on this TPA shall be deemed to appear on each electronically
filed report or return, as if actually appearing thereon. However, if the authorization of the Agent signing this TPA on behalf of the
Taxpayer ends for any reason, the Taxpayer shall enter into a new TPA with the Department. Any failure to comply with this provision
shall result in the Taxpayer being deemed to have filed an incomplete report or return.
4. The Taxpayer shall not contest the validity or enforceability of any report or return filed in electronic form on the basis of the absence
of a paper writing or original, or the absence of a signature thereon. Pursuant to 32.080, RSMo, as amended, any report or return
generated from a report or return filed in electronic form shall be admissible in all courts and administrative agency proceeding.
5. This TPA shall not alter the filing due dates of any report or return, or the additions of any additions to tax imposed for the failure to
timely file and pay complete reports or returns, as set forth in applicable statutes. For purposes of this Agreement, the Taxpayer’s
filing frequency and tax type code shall be:
Withholding Tax:
Bank Account: 8600500
Bank Routing Number: 086507174
Quarter-Monthly (Weekly) 0115P
Monthly 0115A
Quarterly 0115A
Annual 0115A
Corporate Estimated Tax:
Bank Account: 8600505
Bank Routing Number: 086507174
Balance Due 0229C
Quarterly 0219C
Sales and Use Tax:
Bank Account: 1015540
Bank Routing Number: 086500634
Sales Tax Payments 04199
Vendor’s Use Tax Payments 04498
Consumer’s Use Tax Payments 04598
Quarter-Monthly (Weekly) 042 + payment number (01,02,03,04,05)
6. This TPA may be amended only by written amendment executed by the Department and the Taxpayer prior to the effective date
thereof.
7. This TPA may be terminated by either party, with or without cause, upon thirty (30) days written notice.
8. This TPA represents the entire understanding of the parties in relation to the electronic filing of reports or returns.
9. The place of performance of this TPA shall be deemed to be the Missouri Department of Revenue, P.O. Box 629, Jefferson City, MO
65105-0629. This TPA shall be construed according to the laws of the State of Missouri. The Taxpayer shall comply with all local,
state and federal laws to the extent that same may be applicable.
10. Each party represents and warrants that it has all necessary power and authority to enter into and perform this TPA, and that the
person executing this TPA on its behalf is duly authorized to do so.
In witness whereof, and intending to be legally bound hereby, and further intending to bind its agents, successors, heirs and assigns,
the parties have executed this TPA this __________ day of ___________________________________ _________.
Taxpayer’s Name
Taxpayer’s Signature
Title
Taxpayer’s E-mail Address
Primary Contact or Payroll Company
Primary Contact or Payroll Company E-mail Address
Primary Contact or Payroll Company Telephone Number
Primary Contact or Payroll Company Fax Number
(___ ___ ___)___ ___ ___-___ ___ ___ ___
(___ ___ ___)___ ___ ___-___ ___ ___ ___
Form 4572 (Revised 09-2014)
Submit to: Taxation Division
Fax: (573) 526-5915
Visit
for additional information.
Phone: (573) 751-8150
E-mail:
Elecfile@dor.mo.gov
*14500010001*
14500010001

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