Form Tr-370 - Withholding Tax - Registration Application Page 3

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TR-370

Page 3 of 4

(5/03)

. ACH Debit Authorization

If you select the ACH Debit method for electronic payment of withholding taxes, you must complete this section.

I, the undersigned, hereby authorize the New York State Department of Taxation and Finance to debit the bank

account indicated below for the purpose of collecting New York State, New York City, and Yonkers withholding taxes.

Amounts debited shall correspond to information supplied by the undersigned’s company in its electronic filing for

the applicable period.

If I change my bank and/or the account number to be debited, I will complete a new ACH Debit Authorization and

attach a voided check (if available) or include the account number and transit routing number in the spaces

provided.

You may access the PrompTax Web site at: to confirm the effective date and amount of

the tax payment made by the debit transaction.

The Tax Department considers the taxpayer account information on the ACH Debit Authorization confidential and will

use it only for purposes of tax administration.

Important: In the space below, you must attach a voided check (or copy of a voided check) from the account to be

debited, or provide the account and transit routing numbers. The account designated must be a business account,

not one established for family, household, or personal use.

Circle the letter to the left of your selection.

•

Type of account ( check one ):

C - checking

S - savings

(attach a voided

(complete the

check or copy)

information below)

..........................................................................................................................................................................................

Transit routing number:

Account number:

If the account and transit routing numbers indicated above are for a payroll service vendor’s account, check the box

below :

Yes