Form Eft - Appendix G - Electronic Filing Agreement Page 2
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1
2Oklahoma Tax Commission
Electronic Funds Transfer
OKLAHOMA TAX COMMISSION
(To be filled out by O.T.C.)
SIGNED and agreed to on the date first shown above.
ATTEST:
By _______________________________
(Signature)
__________________________________
Name ____________________________
Assistant Secretary
(Typed or printed)
Title _____________________________
TAXPAYER
(To be filled out by Taxpayer)
Taxpayer Federal Identification Number:
By _____________________________
(Signature)
________________________________
Name __________________________
(Typed or printed)
Taxpayer Account Number(s)
Title ____________________________
________________________________
________________________________
By _____________________________
________________________________
Name __________________________
________________________________
(Typed or printed)
________________________________
Title ____________________________
By _____________________________
Name __________________________
(Typed or printed)
Title ____________________________
STATE OF _________________________)
) ss.
COUNTY OF _______________________)
This instrument was acknowledged before me on _______________________, 19__________, by
____________________________________ and ______________________________.
(SEAL)
_________________________________
NOTARY PUBLIC
My Commission Expires: ______________________
EFT
Revision Date: July 27, 2000
Page 29
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