Instructions For Form De 26 - Vendor (Third Party) New Enrollment Request

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Instructions for Completing the Electronic Funds Transfer (EFT) State Data Collector
Program - Vendor (Third Party) New Enrollment Request Form
( )
GENERAL
Please type or print clearly. Return the New Enrollment Request form to the EDD by mail or fax.
This authorization form is for employers who are not currently enrolled in the state data collector
program - vendor (third party) website.
The employer accepts all responsibility for managing access to their profile on the state data
collector system.
Once enrolled, you will receive a confirmation letter with instructions on how to create your profile
and add a bank account to be used for debiting. You will also be able to update your bank account
information directly from the state data collector website.
SECTION I
Complete all information in this section.
Business Name - Enter the business name.
Business Mailing Address - Enter the business mailing address.
Employer Account Number - The EDD employer payroll tax account number is required.
Enter the eight-digit employer payroll tax account number assigned by the EDD, not your
Federal Employer Identification Number.
Business Phone Number - Enter the business phone number.
EFT Contact Person - Enter the name of the person who can be contacted regarding this
enrollment or tax payment inquiries.
EFT Contact Phone Number - Enter the phone number for the contact person.
SECTION II
Preparer or responsible individual, complete all information in this section.
Fax the completed form to 916-654-7441, or
Mail to:
e-Pay Unit, MIC 15A
Employment Development Department
PO Box 826880
Sacramento, CA 94280-0001
If you have questions regarding this form, please call the e-Pay Unit at 916-654-9130.
DE 26 Rev. 10 (6-16) (INTERNET)
Page 2 of 2
CU

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