Instructions For Completing Authorization For Electronic Funds Transfer

Instructions For Completing Authorization For Electronic Funds Transfer - State Of Kansas

Instructions for Completing

AUTHORIZATION FOR ELECTRONIC FUNDS TRANSFER

Indicate if this authorization is a new enrollment application or a revision of an existing one.

PART I – Employer Information

• Tell us your company’s name and address.

• Include the company’s EFT contact, the daytime voice telephone number with area code and extension.

• List the fax number and E-mail, if available.

PART II – Service Bureau - Tax Service

• If you have a service bureau or tax service that is authorized to make your transfers, list the name of the

service bureau and your EFT contact with a daytime voice telephone number and extension.

PART III – ACH Information

• Enclose a voided check for the pre-note test.

• Tell us which account you are authorizing us to transfer funds from and the bank or financial institution in

which it is located.

• Tell us who to call at the bank if there are problems with the transfer.

• We also require the ABA, transit, or routing number.

• Include the daytime voice telephone number plus extension of your EFT contact at your bank.

• Indicate if the account number listed is for a checking or a savings account.

• Indicate if you will be using your telephone’s touch-tone keypad to make your transfer or if you will be using

a rotary dial telephone and will need operator assistance at the Data Collection Center.

PART IV – Authorization

Only an individual who has the authority to permit the use of Electronic Funds Transfer can sign this enrollment

application.

• Identify the individual by name and title.

• Indicate the date the authorization is signed.

Submit the completed authorization to:

Examining Unit - EFT Section

Department of Labor

410 SW Topeka Blvd.

Topeka, KS 66603-3182

Fax: 785-291-3425

If you would like more information about the Electronic Funds Transfer at the Department of Labor, please re-

fer to our transfer guide located on our Web site at Select EMPLOYER/BUSINESS SER-

VICES-ESTABLISH UNEMPLOYMENT INSURANCE TAX ACCOUNT-ELECTRONIC FUNDS TRANSFER.

(This application is available as an Adobe Acrobat Reader PDF file.) The link to this application is on the EFT

page.

You may also call us at 785-296-3762 or E-mail us at uitax@dol.ks.gov.

Instructions For Completing Authorization For Electronic Funds Transfer - State Of Kansas