Form Dr-600a - E-Services Enrollment And Authorization For Other Agency Payments
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2e-Services Enrollment and Authorization
DR-600A
R. 11/17
for Other Agency Payments
Section 1 – Check the Box That Applies
Initial enrollment
Change in filing/payment method
Bank change
Contact information change
Complete all sections
Complete sections 2, 4, 5, and 6
Complete sections 2, 5, and 6
Complete sections 2, 3, and 6
Section 2 – Business Information
Business entity name
Type of remittance/fee
FEIN
License/Permit/Agency number (if different from FEIN)
Physical address
City/State/ZIP
Telephone number (include area code)
Fax number (include area code)
Check Entity Type:
Corporation (check type)
C Corp
S Corp
Partnership (check type)
General
Limited
Joint Venture
Limited Liability Company (check type)
Single Member
Multi-member
Sole Proprietorship
Business Trust
Governmental Agency
Section 3 – Contact Information
Electronic Payment Contact Person’s Information
Name
Mailing address
City/State/ZIP
Telephone number (include area code)
Fax number (include area code)
Email address
Section 4 – Remittance/Fee Type Payment Method Selection
Locate the remittance or fee type, select the payment method you intend to use, and check the appropriate box.
EFT only
EFT only
Type of Remittance or Fee
(ACH-Debit)
(ACH-Credit)*
-
DMS
Florida Retirement System contributions
-
DMS
Division of State Group Insurance premiums (universities)
BPR - Beverage and Tobacco taxes and fees
o Liquor
o Beer
o Imported Wine
o Domestic Wine
o Direct Wine
o Cigarette Stamp
o Other Tobacco
o Passenger Vessel
-
BPR
Pari-Mutuel taxes and fees
-
BPR
Pari-Mutuel slot receipts and fees
-
BPR
Pari-Mutuel cardroom receipts and fees
*
You must supply a letter that states a valid business reason for selecting the ACH-Credit payment method. Valid reasons include your previous use of
this method in other business-related activities, or internal controls within your business regarding ACH transfers.
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