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Form Eft-1 Wh - Withholding Tax Authorization Agreement For Touchtone Telephone Payments

State of Arkansas

EFT-1 WH

Department of Finance and Administration

Withholding Tax Authorization Agreement for Touchtone Telephone Payments

Please print information clearly in blue or black ink.

Eight Digit Account ID ___ ___ ___ ___ ___ ___ ___ ___

Name of Business or Organization ____________________________________________________

Primary EFT Contact Person ______________________________ Phone_____________________

Mailing Address _________________________________________ FAX _____________________

City, ST, ZIP___________________________ Email Address ______________________________

Check one of the following boxes:

Initial Filing of the Form

Change in Contact Information

Change of Banking Information

Effective Date

Changes in Bank information must be submitted on this form with the new information at least 10 days prior to your next

payment date.

Bank Name______________________________________________

Checking

Savings

Routing Number (9 digits) ___ ___ ___ ___ ___ ___ ___ ___ ___

Bank Account Number ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___

Choosing the Touchtone Telephone option authorizes the Department of Finance and Administration or its agent to

present debit entries to your bank for payments of your sales tax liabilities. Before any debit entries are made to your bank

account, you must first initiate the debit by calling the state's service bureau at its toll free number and follow the

instructions from the instruction card. An information packet with the instruction card and toll free telephone number will be

mailed to the primary contact person upon completion of this form. If you do not receive the instruction card before the due

date of your required EFT payment contact a customer service representative at (501) 682-7290 .

Signature of owner or officer ________________________________________________________

EFT Unit

Complete this form and return to:

Withholding Tax Branch

P.O. Box 9941

Little Rock, AR 72203-9941

For Office Use Only

TAX TYPE CODES:

01100

Form Eft-1 Wh - Withholding Tax Authorization Agreement For Touchtone Telephone Payments