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City of Brook Park Ohio

IMPORTANT NEW FILING REQUIREMENT FOR YOUR WITHHOLDING ACCOUNT

ON OCTOBER 20, 1998, COUNCIL OF THE CITY OF BROOK PARK AMENDED SECTION 1713.02 OF THE CODIFIED ORDINANCE

TO MANDATE WITHHOLDING TAX PAYMENTS BY ELECTRONIC FUNDS TRANSFER FOR EVERY EMPLOYER AND REQUIRED

TO DEDUCT AND WITHHOLD TAX.

IF YOU NEED TO CONVERT TO ELECTRONIC FUNDS TRANSFER, COMPLETE THE APPLICATION BELOW AND SUBMIT IT TO

THE DEPARTMENT OF TAXATION.

Two different systems are offered:

1.) The ACH debit (touch-tone phone) approach allows you to program your transaction from two to thirty days in advance

of the transaction date and the Huntington Bank will automatically retrieve the funds on the transaction date via the TAX

EXPRESS SYSTEM, or

2.) The ACH credit approach which automatically transfers the money on the effective date of the transaction you initiate.

(Specific TXP format and addendum record requirements)

CITY OF BROOK PARK TX ACCOUNT NUMBER __________________________________________________________

FEDERAL ID NUMBER _______________________________________________________________________________

PREFERRED METHOD OF TRANSACTION:

ACH Debit _________________________________________________

ACH Credit _________________________________________________

(IF ACH CREDIT DO NOT COMPLETE 1 THROUGH 4)

1.) Company Name: ______________________________________________________________________________________________

Address: _________________________________________________________________________________

_________________________________________________________________________________

2.) Financial Institution Name: ______________________________________________________________________________________

3.) Financial Institution’s ABA/Routing Number: ________________________________________________________________________

4). Bank Account Number: _________________________________________________________________________________________

Contact Person: _________________________________________________________________________________________________

(Please Print)

Phone Number: ____________________________________________ Fax Number: __________________________________________

Signature: ___________________________________________________________ Date: _____________________________________

Information provided on this form is confidential and is used for City Income Tax purposes only.

Return the enclosed enrollment form with your choice and applicable papers will be forwarded to you. Questions can be

answered by calling (216) 433-1533 between 9AM and 3:30PM.

PLEASE PRINT LEGIBLY

EFTREG

Form Rftreg - Withholding Account Electronic Funds Transfer Application Form - City Of Brook Park