NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
ELECTRONIC FUNDS TRANSFER
AUTOMATED CLEARING HOUSE CREDIT PROGRAM GUIDE
NEW HAMPSHIRE’S REVENUE ADMINISTRATION BANK ACCOUNT INFORMATION WILL BE PROVIDED TO YOU
ALONG WITH THE DEPARTMENT'S APPROVAL FOR THE NEW HAMPSHIRE EFT ACH CREDIT PROGRAM.
New Hampshire requires all taxpayers having a total liability for Business Profits Tax, RSA 77-A, and/or a Business Enterprise Tax, RSA
77-E, of $100,000 or greater for the most recently filed tax year to submit tax payments by Electronic Funds Transfer (EFT), either by the
ACH Credit or ACH Debit method. Taxpayers with tax liabilities under the mandatory threshold of $100,000 may also voluntarily
participate in New Hampshire’s EFT programs.
If you meet the mandatory threshold to make your tax payments via ACH Credit, you must submit this form to register as an ACH Credit
taxpayer with the New Hampshire Department of Revenue Administration. If you are below the mandatory threshold, but wish to
voluntarily participate in the ACH Credit program, you must submit this form to register with the Department. The information provided on
this form should include the name, address and telephone number of the primary and a secondary contact person(s) for ACH Credit
purposes. In addition, this form should be used to report any changes in your registration information (i.e., a change in taxpayer contact,
telephone number, etc). This form is available in the ACH Credit Program Information Guide. Please contact the Department of Revenue
Administration at (603) 271-2192 for the complete EFT ACH Credit Program Guide.
This form must be filed at least 30 days prior to the due date of your first ACH Credit payment. Any changes in the registration information
must be provided to the Department at least 30 days prior to the change. Any changes of financial institution and contacts require
additional prenote tests.
All taxpayers participating in New Hampshire’s ACH Credit program are required to complete a successful Prenote Test at least 10
calendar days prior to the due date of their first ACH Credit payment. Do not send payment via ACH Credit until you have received
confirmation of a successful prenote.
New Hampshire Department of Revenue Administration, Document Processing Division, PO Box 1004, Concord, NH 03302-1004.
W H E R E
Call Central Taxpayer Services at (603) 271-2191.
Hearing or speech impaired individuals may call TDD Access: Relay NH 1-800-735-2964.
Electronic Funds Transfer ACH Credit
Registration for Business Tax Payments
PLEASE PRINT OR TYPE
PROPRIETOR'S SOCIAL SECURITY NUMBER
FEDERAL EMPLOYER IDENTIFICATION NUMBER
DEPARTMENT IDENTIFICATION NUMBER
Check one of the following:
NOTE: If you are a Corporation and a
Combined group, you must check Combined.
PRIMARY CONTACT PERSON
SECONDARY CONTACT PERSON
NUMBER & STREET ADDRESS
CITY/ TOWN, STATE & ZIP CODE
Please check one of the following:
FOR DRA USE ONLY
FOR DRA USE ONLY
NH DEPT OF REVENUE ADMINISTRATION
DOCUMENT PROCESSING DIVISION
PO BOX 1004
CONCORD NH 03302-1004
THIS REGISTRATION IS FOR THE ACH CREDIT PROGRAM ONLY. FOR INFORMATION ON NH'S ACH DEBIT PROGRAM VISIT US
ON THE WEB AT YOU DO NOT HAVE TO REGISTER TO FILE ACH DEBIT.