Form Boe-555-Eft - Instructions For Completing The Eft Authorization Agreement Form printable pdf download

Form Boe-555-Eft - Instructions For Completing The Eft Authorization Agreement Form

BOE-555-EFT (BACK) REV. 7 (4-16)

Instructions for Completing the EFT Authorization Agreement Form

TAXPAYER AND CONTACT INFORMATION

Please type or print clearly.

Complete all the blocks in the section. Your State Board of Equalization (BOE) account number is required (for example, 30-123456).

Make a copy of the completed form for your records.

Payment OPTIONS

Complete and sign OPTION 1 (ACH Debit) or OPTION 2 (ACH Credit). DO NOT COMPLETE BOTH.

Complete every block of information for the method selected.

If the ACH Debit method is selected, attach a voided check or a bank specification sheet so we can verify your bank account number and

routing number.

The example voided check below indicates where to locate the routing number and bank account number. Some financial institutions may

use a different routing number for electronic payments than the one used for paper checks. You may want to verify the information with your

financial institution before submitting it. Do NOT use a deposit slip to obtain the information requested. Failure to enter the correct banking

information may cause your payment to be rejected and may subject your account to delinquency charges.

Remember to mark the word “void” across the face of the check that you send with the authorization agreement.

Routing Number

(requires 9 digits)

Bank Account Number

(not to exceed 17 digits)

Check Number

Important Information

EFT Start Date for New Accounts

You will be notified in writing if your agreement is approved. The confirmation letter will indicate when you must start making EFT payments.

DO NOT attempt to pay by EFT before your approved start date.

Removal from EFT

Once you are registered, you cannot withdraw from the EFT program unless you submit a written request and you receive a written approval from the BOE.

You can fax the request to 1-916-322-8457 or mail it to EFT Group, P.O. Box 942879, Sacramento, CA 94279-0035. You must continue to make payments

by EFT until the BOE notifies you in writing that your request has been approved and indicates the ending date for making EFT payments.

Note: If your account is closing out, a written request for removal from EFT is not required.

Changing Your Payment Method (ACH Debit vs. ACH Credit)

If you are submitting an authorization agreement form to change from ACH Debit to ACH Credit, or vice versa, you must continue to use your current

payment method until you are notified in writing by the BOE that your request has been approved. A confirmation letter will be mailed to you once your

method of payment has been changed.

New Bank Account or Routing Number

If you are submitting an authorization agreement form to change your bank account or routing number, you will not receive a confirmation letter.