Form 90-303 - Iowa Authorization For Direct Deposit Of Motor Fuel Tax Refunds

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Iowa Department of Revenue
Iowa Authorization for Direct Deposit
of Motor Fuel Tax Refunds
This form is for direct deposit of refunds only. It is not to be used for paying taxes.
Company Name and Address: (Please Print)
Motor Fuel Refund Number: _______________
___________________________________________
___________________________________________
___________________________________________
___________________________________________
Financial Institution Account Information:
1. Type of Account:
Savings
Checking
2. Bank Routing Number:
3. Financial institution account number:
4. Will the refund be deposited into an account outside the United States?
Yes
No
5. Send a voided check as proof of account ownership
Company Contact Information:
Contact Name (Please Print): ______________________________________________________________________
Mailing Address of Contact Person: ________________________________________________________________
Telephone Number: _______________________________ Fax Number: __________________________
e-Mail Address _________________________________________________________________________
Authorized Signature: _________________________________________________ Date: ____________________
All information on this form is confidential.
File your refund claim as usual.
Your refund will be directly deposited into your account.
Questions?
Contact us at 1-800-338-4692 or IDREFT@iowa.gov
or fax it to:
or e-Mail to:
Complete this form and send to:
EFT Unit
515-281-5830
IDREFT@iowa.gov
Iowa Department of Revenue
PO Box 10413
Des Moines IA 50306
90-303 (10/21/09)

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