Form 3117 - City Of Albion Eft Application

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Michigan Department of Treasury - CTU
MAIL TO: City Tax Unit
3117 (Rev. 7-99)
Michigan Department of Treasury
P.O. Box 30665
CITY OF ALBION EFT APPLICATION
Lansing, MI 48909-8165
Issued under P.A. 284 of 1964, as amended.
Filing is mandatory.
Complete this application and select the method you will use to file electronically. If you select the ACH
Credit method, electronic filing may begin after you receive our approval. If you select the ACH Debit
method, electronic filing may begin after you receive filing instructions from our bank.
Federal Identification No.
Company Name and Address
Telephone
Contact Person
Please indicate the type of tax(es) you will be paying by EFT:
Withholding
Corporate Estimates
Partnership Estimates
(01150)
(02150)
(01850)
FOR STATE USE ONLY
(7001)
(7002)
(7003)
Filing method (please check only one):
1.
ACH Credit
Treasury will approve requests for the ACH credit method if you agree to follow the format that we have adopted.
You must also send a prenote (completely formatted) electronically as a test before beginning actual filing. Remember
to complete and file form 3121 along with this form.
2.
ACH Debit (TRAN CODE 27)
If you select the ACH debit method, indicate how you will contact our bank (by computer or phone) and supply your
bank name, ABA number and your bank account number. Our bank will then send you detailed instructions for
making your payment. No prenote is required. Remember to complete and file forms 3120 and 3121 along with this
form.
Computer Terminal
Touchtone Phone
Rotary Phone
Your Bank's Name
Bank's ABA Number
Your Bank Account No.
I agree to follow the format adopted by the Michigan Department of Treasury for withholding and corporate or partnership estimated
tax payments. I will also send an electronic prenote as a test. I agree to notify Treasury in advance of any change in my filing method.
Signature of Authorized Representative
Date
Print Name of Authorized Representative
Officer/Title
Mail this form to Treasury for approval. We will sign it and return it to you. Do not begin filing
electronic payments until this form is signed and returned to you.
Treasury Approval
Date
FOR STATE USE ONLY-659083
Customer No.
User No.
/
Password
GCM Approval
ABO Approval
Date

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