Form 104-Ep - Estimated Income Tax Payment Voucher - 2005

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DR 104EP (09/22/05) Web
COLORADO DEPARTMENT OF REVENUE
DENVER, CO 80261-0008
Do you want to avoid mailing estimated tax forms and payments?
File and pay your estimated income taxes electronically online or with one toll-free call, without writing a check or mailing a form.
The system also lets you establish a payment schedule for the year so you won’t forget to make your quarterly payment. The Web
version shows your planned payments and payment history. Payments are transferred to the Department of Revenue and
credited to your account on the day you request; convenient and secure.
To sign up, fill out the next page and send to
Colorado Department of Revenue
CDO Research
Denver, CO 80261
Or fax to (303) 866-3112
Sample Check:
9 Digit Routing Number
DETACH FORM
ON THIS LINE
DR 5774 (08/16/05)
EFT AUTHORIZATION
EFT Number
COLORADO DEPARTMENT OF REVENUE
DENVER CO 80261
3 7 1 0
INDIVIDUAL ESTIMATED INCOME TAX
___ ___ ___ ___ ___ ___ ___ ___ ___ ___
(303) 205-8333
To be assigned by Department of Revenue
Taxpayer Name
01204
Mailing Address
Social Security Number
City
State
ZIP
Contact Person
Phone
(
)
I authorize the Colorado Department of Revenue,
pursuant to my instructions, to initiate entries to my account number ________________________ at __________________________________ bank.
Name of Bank Account
Type of Account
Checking
Savings
Bank Transit/Routing Number
Signature
Date
A VOIDED CHECK FOR THE BANK ACCOUNT INDICATED ABOVE MUST ACCOMPANY APPLICATION

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