Electronic Funds Transfer Authorization Agreement
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2VIRGINIA DEPARTMENT OF TAXATION
ELECTRONIC FUNDS TRANSFER AUTHORIZATION AGREEMENT
ALL TAXPAYERS AND PAYROLL SERVICE PROVIDERS, COMPLETE SECTION A.
A.
Legal Name of Business or Organization:
P
A
Phone (
)
Primary EFT Contact:
Y
E
Entity Type – Circle One:
Business Taxpayer
Payroll Service Provider
R
Email Address:___________________________________________________
I
N
Mailing Address for EFT Information:
F
O
Street ___________________________________________________
City
State
Zip
- _________
Note to Payroll Service Providers / Bulk Filers – you do not need to provide the Department with a list of your clients. Simply complete
section A and mail or fax to the Department. We will then provide you with the state’s bank information. Also, if you provide an email
address, the Department will add you to a tax professional mailing group and provide you with timely updates regarding EFT processing
requirements and any form or legislative changes that may impact your clients.
IF CHOOSING THE DEBIT PAYMENT METHOD, COMPLETE THIS SECTION
Check to indicate
Tax Type
Account Number (s) Bank Account Number(s)
Bank Routing & Transit
B.
Account Type
Number(s)
D
Checking Savings
E
)
1
B
Withholding
(VA Tax Account Number)
I
T
)
2
(Federal ID Number - FEIN)
E
Checking Savings
F
)
1
T
Corporation
(VA Tax Account Number)
---
B
A
)
2
(Federal ID Number - FEIN)
N
K
Checking Savings
)
1
I
(VA Tax Account Number)
Sales & Use
N
F
)
(Federal ID Number - FEIN)
2
O
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