Form 8878-A - Irs E-File Electronic Funds Withdrawal Authorization For Form 7004
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28878-A
IRS e-file Electronic Funds Withdrawal
Form
Authorization for Form 7004
OMB No. 1545-1927
(Rev. December 2008)
Department of the Treasury
See instructions. Do not send to the IRS. Keep for your records.
Internal Revenue Service
For calendar year 20
or tax year beginning
, 20
, ending
, 20
Name on Form 7004
Identifying number
Part I
Information From Form 7004 (Whole Dollars Only)
1
1
Tentative total tax (Form 7004, line 6)
2
2
Total payments and credits (Form 7004, line 7)
3
Balance due (Form 7004, line 8)
3
Part II
Authorized Person’s Declaration and Signature Authorization
Under penalties of perjury, I declare that I have been authorized by the above taxpayer to make this authorization and that I have
examined a copy of the taxpayer’s electronic Form 7004 for the tax year indicated above. I further declare that the amounts in Part
I above are the amounts shown on the copy of the taxpayer’s electronic Form 7004. I consent to allow my electronic return originator
(ERO), transmitter, or intermediate service provider to send this authorization to the IRS with the electronic Form 7004 and to receive
from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, and (b) the reason for any delay in
processing the form. I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal
(direct debit) entry to the financial institution account indicated in the tax preparation software for payment of the taxpayer’s balance
due on Form 7004, and the financial institution to debit the entry to this account. To revoke a payment, I must contact the U.S.
Treasury Financial Agent at 1-888-353-4537 no later than 2 business days prior to the payment (settlement) date. I also authorize
the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary
to answer inquiries and resolve issues related to the payment. I have selected a personal identification number (PIN) as my signature
for the taxpayer’s consent to electronic funds withdrawal.
Authorized Person’s PIN: check one box only
I authorize
to enter my PIN
as my signature
ERO firm name
do not enter all zeros
for the taxpayer’s consent to electronic funds withdrawal for the balance due on the taxpayer’s electronic Form 7004 for
the tax year indicated above.
I will enter my PIN as my signature for the taxpayer’s consent to electronic funds withdrawal for the balance due on the
taxpayer’s electronic Form 7004 for the tax year indicated above.
Authorized person’s signature
Date
Title
Part III
Certification and Authentication
ERO’s EFIN/PIN. Enter your six-digit EFIN followed by your five-digit self-selected PIN.
do not enter all zeros
I certify that the above numeric entry is my PIN, which is my signature to authorize submission of the electronic funds withdrawal
authorization with the electronic Form 7004 for the taxpayer indicated above. I confirm that I am submitting this authorization with
Form 7004 in accordance with the requirements of Pub. 3112, IRS e-file Application and Participation, and Pub. 4163, Modernized
e-File (MeF) Information for Authorized IRS e-file Providers for Business Returns.
ERO’s signature
Date
ERO Must Retain This Form — See Instructions
Do Not Submit This Form to the IRS Unless Requested To Do So
8878-A
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 39223B
Form
(Rev. 12-2008)
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