Form 4572 - Electronic Filing Trading Partner Agreement (Tpa)
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Form
Missouri Department of Revenue
4572
Electronic Filing Trading Partner Agreement (TPA)
For ACH File Specifications you can access the Department’s website at
to download the
Electronic File Specifications and Record Layouts for EFT of Business Tax Return and Payment Using ACH Credit with TXP Addendum
(Form
4585).
This TPA between the Missouri Department of Revenue (Department) and __________________________________________
d/b/a _____________________________________________________________________________,(Taxpayer) is entered into
pursuant to authority given in the Revised Statutes of Missouri (RSMo) and the Code of State Regulations (CSR).
The Department and the Taxpayer agree as follows:
1. The Department authorizes the Taxpayer to file Missouri withholding payments and returns, corporate income tax payments,
or sales and use tax payments required to be filed with the Department, pursuant to Chapters 143 and 144, RSMo, by means of
electronic transmission.
2. Each tax report or return filed in electronic form pursuant to this TPA shall for all purposes be considered a “writing,” “signed
by the Taxpayer” and an “original” report or return.
3. The signature of the Taxpayer or the Taxpayer’s authorized agent (Agent) on this TPA shall be deemed to appear on each
electronically filed report or return, as if actually appearing thereon. However, if the authorization of the Agent signing this
TPA on behalf of the Taxpayer ends for any reason, the Taxpayer shall enter into a new TPA with the Department. Any
failure to comply with this provision shall result in the Taxpayer being deemed to have filed an incomplete report or return.
4. The Taxpayer shall not contest the validity or enforceability of any report or return filed in electronic form on the basis of
the absence of a paper writing or original, or the absence of a signature thereon. Pursuant to 32.080, RSMo, as amended,
any report or return generated from a report or return filed in electronic form shall be admissible in all courts and
administrative agency proceeding.
5. This TPA shall not alter the filing due dates of any report or return, or the additions of any additions to tax imposed for the
failure to timely file and pay complete reports or returns, as set forth in applicable statutes. For purposes of this Agreement,
the Taxpayer’s filing frequency and tax type code shall be:
Withholding Tax:
Bank Account: 8600500
Bank Routing Number: 086507174
r
r
r
r
Quarter-Monthly (Weekly) 0115P
Monthly 0115A
Quarterly 0115A
Annual 0115A
Corporate Estimated Tax: Bank Account: 8600505
Bank Routing Number: 086507174
r
r
Balance Due 0229C
Quarterly 0219C
Sales and Use Tax:
Bank Account: 1015540
Bank Routing Number: 086500634
r
r
Quarter-Monthly (Weekly) 042 + payment number (01,02,03,04,05)
Sales Tax Payments 04199
r
r
Vendor’s Use Tax Payments 04498
Consumer’s Use Tax Payments 04598
6. This TPA may be amended only by written amendment executed by the Department and the Taxpayer prior to the effective
date thereof.
7. This TPA may be terminated by either party, with or without cause, upon thirty (30) days written notice.
8. This TPA represents the entire understanding of the parties in relation to the electronic filing of reports or returns.
9. The place of performance of this TPA shall be deemed to be the Missouri Department of Revenue, P.O. Box 629, Jefferson
City, MO 65105-0629. This TPA shall be construed according to the laws of the State of Missouri. The Taxpayer shall
comply with all local, state and federal laws to the extent that same may be applicable.
10. Each party represents and warrants that it has all necessary power and authority to enter into and perform this TPA, and
that the person executing this TPA on its behalf is duly authorized to do so.
In witness whereof, and intending to be legally bound hereby, and further intending to bind its agents, successors, heirs and
assigns, the parties have executed this TPA this ________ day of ______________________ _________.
Day
Month
Year
Taxpayer’s Name
Taxpayer’s Signature
Title
Missouri Tax I.D. Number
Federal Employer I.D. Number
Taxpayer’s E-mail Address
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Primary Contact or Payroll Company
Primary Contact or Payroll Company Telephone Number
(___ ___ ___)___ ___ ___-___ ___ ___ ___
Primary Contact or Payroll Company Fax Number Primary Contact or Payroll Company E-mail Address
(___ ___ ___)___ ___ ___-___ ___ ___ ___
Form 4572 (Revised 08-2013)
Submit to:
Taxation Division
Phone: (573) 751-8150
Fax: (573) 526-5915
E-mail: Elecfile@dor.mo.gov
Visit
for additional information.
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