Form R-20193-L - Authorization Agreement For Ach Debit And Credit Tax Payments

Download a blank fillable Form R-20193-L - Authorization Agreement For Ach Debit And Credit Tax Payments 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 R-20193-L - Authorization Agreement For Ach Debit And Credit Tax Payments 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

R-20193-L (9/09)
Authorization Agreement for
ACH Debit and Credit Tax Payments
New Application
Change Document
(effective date):
(effective date):
PLEASE PRINT OR TYPE.
Taxpayer name
Revenue Account Number
A separate authorization is required for each tax.
Tax type – Enter the tax type name.
Federal Identification Number
(if applicable)
Contact person
Telephone
Contact person
Telephone
Mailing address for EFT purposes (street address, box number)
City
State
ZIP
Electronic Payment Methods
ACH Debit
I hereby authorize the Louisiana Department of Revenue to present debit entries into the bank account and the depository named
below. The individual debit transactions will be presented only after being authorized and initiated by the taxpayer. These debits will
pertain only to electronic funds transfer payments that the taxpayer has initiated for payment of Louisiana taxes.
Signature
Title
Date
X
Bank name
Branch
Bank contact person
Telephone
Bank account number
Type of account
Checking
Savings
Transit and
Name on bank account
–
routing number
ACH Credit
Before choosing the ACH Credit option, check with your financial institution to ensure that they can comply with the ACH Credit addenda
record requirements. See instructions for more information.
Mail Application to:
For office use only.
Louisiana Department of Revenue
EFT Processing
Effective tax period
Initials
9805
P.O. Box 3863
Baton Rouge, LA 70821-3863

ADVERTISEMENT

00 votes

Related Articles

Top 20 Happy Easter Cards And Gift Tags To Download For Free
Top Ten Easter Arts And Crafts Activities For Your Kids
Free Easter Coloring Pages And Easter Printables For Your Kids

Related forms

Form R-20193-l - Authorization Agreement For Ach Debit And Credit Tax Payments Form R-20193-l - Authorization Agreement For Ach Debit And Credit Tax Payments Financial
Form R-20193-l - Authorization Agreement For Electronic Funds Transfer (eft) Of Tax Payment Form 1999 Form R-20193-l - Authorization Agreement For Electronic Funds Transfer (eft) Of Tax Payment Form 1999 Financial
Form Eft-001 - Electronic Funds Transfer Authorization Agreement For Ach Debit Payment Method Form Eft-001 - Electronic Funds Transfer Authorization Agreement For Ach Debit Payment Method Financial
Authorization Agreement For Ach Debit Origination - Tennessee Credit Union Authorization Agreement For Ach Debit Origination - Tennessee Credit Union Business
Form Eft-2 - Authorization Agreement For Ach Debit Electronic Funds Transfer Form Eft-2 - Authorization Agreement For Ach Debit Electronic Funds Transfer Financial
Form Eft-2 - Authorization Agreement For Ach Debit Electronic Funds Transfers Form Eft-2 - Authorization Agreement For Ach Debit Electronic Funds Transfers Legal
Form Eft-001 - Electronic Funds Transfer Authorization Agreement For Ach Credit Payment Method - 2007 Form Eft-001 - Electronic Funds Transfer Authorization Agreement For Ach Credit Payment Method - 2007 Financial
Form Eft: 001 - Electronic Funds Transfer Authorization Agreement For Ach Credit Payment Method Form Eft: 001 - Electronic Funds Transfer Authorization Agreement For Ach Credit Payment Method Financial
Authorization Agreement For Ach Direct Deposits Ach Origination Form Authorization Agreement For Ach Direct Deposits Ach Origination Form Business
Form Rev-331a Ec - Authorization Agreement For Electronic Tax Payments Form Rev-331a Ec - Authorization Agreement For Electronic Tax Payments Financial

Related Categories

Parent category: Financial
Download
Go