Form Eft-100s - Electronic Funds Transfer Authorization Agreement For Streamlined Sales Tax

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Electronic Funds Transfer Authorization
EFT-100S
Web
Agreement for Streamlined Sales Tax
11-06
North Carolina Department of Revenue
Name
(First 30 Characters) (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
Office Use
Federal Employer ID Number
Only
Address
Social Security Number
City
State
Zip Code (First 5 digits)
Fill in applicable circle:
Name of Contact Person
Phone Number
Initial registration - voluntary participant
Change of Information/Bank Change
Title
Fax Number
(Effective Date: ___________ )
Streamlined Sales Account ID
Address
0 0 S
City
State
Zip Code (First 5 digits)
Fill in applicable circle for tax type:
Streamlined Sales and Use
General Instructions
Complete Part 1 and Part 2 to register for the ACH Credit method.
Taxpayers that wish to remit Streamlined Sales Tax by the ACH Debit method, may do so using the SSTP XML Payment Schema when
submitting the Streamlined Simplified Electronic Return (SER) or separately. Both require the use of web services to submit the XML Schema.
Additional information about the Streamlined XML Schemas can be found on the website for the Streamlined Sales Tax Governing Board, Inc.
at by clicking on the SST Technology link. ACH Debit payments thru Touchtone, PC Software, or Voice
input methods are not available for Streamlined Sales Tax in NC.
Part 1.
ACH Credit payment method for Streamlined Sales and Use Tax
Part 2.
Authorized Signature
(ACH Credit filers must complete this certification.)
I certify that the individual named above as the contact person is authorized to act on behalf of the taxpayer.
Authorized Signature
Title
Date
MAIL TO: Electronic Funds Transfer Section
North Carolina Department of Revenue
P.O. Box 25000
Raleigh, North Carolina 27640-0001

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