Form Dr 5778 - Eft Authorization Corporate Estimated Income Tax Ach Debit/form 112ep - Corporate Estimated Tax Payment Vouchers - 2010

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DO yOU WANT TO AVOID MAILING ESTIMATED TAX FORMS AND PAyMENTS?
The department offers a variety of convenient and secure ways to make estimated income tax payments electronically without
writing a check or mailing a form. Payments can be made be eCheck or credit card through the Official State Web Portal or by ACH Credit
or ACH Debit through the department’s Electronic Payment (EFT) service. The web portal can be accessed online at
and no prior registration is required in order to make payments. The EFT service does require prior registration,
but also allows for the establishment of a payment schedule and provides a detail of planned payments and payment history. Additional
information regarding the EFT service is available online at
To sign up, fill out the information below and send to:
Colorado Department of Revenue
Sample Check:
CDO Research
Denver, CO 80261
or fax to (303) 866-3112
DR 5778 (10/07/09)
EFT Number
EFT AUThORIzATION CORPORATE
COLORADO DEPARTMENT OF REVENUE
DEnVER CO 80261
ESTIMATED INCOME TAX ACh DEbIT
(303) 205-8333
___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Vendor ID
To be assigned by Department of Revenue
Taxpayer Name
Colorado Account Number
Mailing Address
Federal Employer Identification number (FEIn)
01212
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
ATTACh A VOIDED ChECK FOR ThE bANK ACCOUNT INDICATED AbOVE
DR 5778A (10/07/09)
EFT AUThORIzATION CORPORATE
EFT Number
COLORADO DEPARTMENT OF REVENUE
DEnVER CO 80261
ESTIMATED INCOME TAX ACh DEbIT
(303) 205-8333
___ ___ ___ ___ ___ ___ ___ ___ ___ ___
Vendor ID
To be assigned by Department of Revenue
Taxpayer Name
Colorado Account Number
Mailing Address
Federal Employer Identification number (FEIn)
01212
City
State
ZIP
Contact Person
Phone
(
)
I hereby request the Colorado Department of Revenue (DOR) grant authority for the taxpayer to initiate Automated Clearing House credit
transactions to DOR’s bank account. I understand these must be in the nACHA CCD+ format using the TXP addendum record format.
Signature
Date

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