Form Bfs-152 - Application For Basic Driver Improvement Course Program Electronic Funds Transfer (Eft) - Michigan Department Of State
Download a blank fillable Form Bfs-152 - Application For Basic Driver Improvement Course Program Electronic Funds Transfer (Eft) - Michigan Department Of State in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Bfs-152 - Application For Basic Driver Improvement Course Program Electronic Funds Transfer (Eft) - Michigan Department Of State with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Clear Form
APPLICATION FOR BASIC DRIVER IMPROVEMENT COURSE PROGRAM
ELECTRONIC FUNDS TRANSFER (EFT)
To be considered for participation in the Michigan Department of State’s Electronic Funds Transfer (EFT) program,
please provide the information requested below. Upon approval, your authorizing signature permits the Department of
State to electronically transfer funds from your financial institution to a State of Michigan account.
– PLEASE KEEP A COPY OF THIS APPLICATION FOR YOUR FILES –
NOTE: This application must be completed when you first apply to participate in the EFT program OR you
change banks OR you have a bank account number change. You may either mail or fax your application to:
Michigan Department of State
Revenue Accounting Section
7064 Crowner Drive
Lansing, MI 48918
FAX: (517) 373-1306
Attn: Kate Lintner
COMPANY NAME ______________________________________________________________________________________
ADDRESS ______________________________________________________________________________________________
CITY __________________________ COUNTY ___________________________ STATE ____________ ZIP _____________
TELEPHONE NUMBER (
) ____________________________ FAX NUMBER (
) ____________________________
PROVIDER NUMBER (if any) _____________ CONTACT PERSON _______________________________________________
AUTHORIZATION FOR VARIABLE WITHDRAWALS -- AUTOMATED CLEARING HOUSE DEBITS
I hereby authorize the Department of State to make withdrawals from the account identified below at:
___________________________________________________________________________________________________________________
(Depository Financial Institution, hereinafter referred to as DFI)
and authorize the DFI to charge such withdrawals to my listed account.
Because these regular payments may vary in amount, the Department of State will provide a summary of all work processed.
If the purpose for withdrawal is restricted in any manner, such restriction is stated below. Adjusting entries to correct errors are also authorized.
It is agreed that these withdrawals and adjustments may be made electronically and under the Rules of the Michigan Automated Clearing House
Association. This authorization will remain in effect until written notice of termination is given to the Department of State.
DFI NAME
DFI ROUTING AND TRANSIT NUMBER
ACCOUNT NUMBER TO DEBIT
TYPE OF ACCOUNT
CHECKING
PRINTED NAME OF AUTHORIZING PARTY
ADDRESS
CITY
STATE
ZIP
SIGNATURE OF AUTHORIZING PARTY
DATE
FEDERAL I.D. NUMBER
IS THIS A NEW EFT ACCOUNT?
IS THIS A BANK ACCOUNT CHANGE?
DATE WHEN OLD ACCOUNT
ESTIMATED AMOUNT TO
WILL NO LONGER BE USED
BE TRANSFERRED DAILY
YES
NO
YES
NO
$
PLEASE ATTACH A VOIDED CHECK AND A DEPOSIT TICKET TO THIS APPLICATION
BFS-152 (09/2010)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Eft-1 - Authorization Agreement For Electronic Funds Transfer (eft) - Hawaii Department Of Taxation
Financial
Form Dp-175 - Registration For Electronic Funds Transfer - New Hampshire Department Of Revenue
Financial
Form Mf-10 - Application For Special Pre-paid Lp-gas User Permits And Decals - Kansas Department Of Revenue
Legal
Form 5473 - City Of Detroit Electronic Funds Transfer (eft) Debit Application, Account Update - Michigan Department Of Treasury
Financial
Form De 26 - Electronic Funds Transfer (eft) State Data Collector Program - Vendor (third Party) New Enrollment Request Form
Legal
Form 4536 - Authorization Agreement For Electronic Funds Transfer (eft) Of Withholding Tax Payments Form - State Of Missouri
Financial
Form Dr 5785 - Authorization For Electronic Funds Transfer (eft) For Tax Payments - Colorado Department Of Revenue
Financial
Form 4536 - Autorization Agreement For Electronic Funds Transfer (eft) Of Withholding Tax Payments - Missouri Department Of Revenue
Financial
Related Categories
Parent category: Legal