Form Boe-555-Eft - Authorization Agreement For Electronic Funds Transfer (Eft)
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2BOE-555-EFT (FRONT) REV. 6 (4-06)
STATE OF CALIFORNIA
AUTHORIZATION AGREEMENT FOR
BOARD OF EQUALIZATION
ELECTRONIC FUNDS TRANSFER (EFT)
New EFT account
Change EFT reporting method
Please Check Appropriate Boxes:
Change bank account on
(date)
See reverse for instructions.
Change contact name or phone number
(Type or Print in Ink)
SECTION I
TAXPAYER NAME
BOE ACCOUNT NUMBER
DBA (doing business as)
BUSINESS PHONE NUMBER
(
)
—
CONTACT PERSON
CONTACT PHONE NUMBER
(
)
—
Complete and sign either Section II or III below (not both)
SECTION II
ACH Debit
The State Board of Equalization is hereby authorized to initiate debit entries to the bank account identified below and the bank is authorized
to debit such account. This authority is to remain in full force until EFT payments are no longer required by statute or, if I am a voluntary
participant, until the State Board of Equalization and I mutually agree to terminate my participation in the EFT program.
BANK NAME
TYPE OF ACCOUNT
BANK ACCOUNT NUMBER (not to exceed 17 digits)
Checking
Savings
ROUTING NUMBER:
SIGNATURE
TITLE
DATE
IMPORTANT: If you have selected the ACH Debit option, you must attach a voided check for the account to be debited. Your voided check will
verify bank account and routing numbers. If you are unable to provide a voided check, a bank specification sheet may be used
instead of the voided check.
SECTION III (Do not complete if you have completed Section II above.)
ACH Credit
The State Board of Equalization is hereby requested to grant authority for the above‑named taxpayer to initiate ACH credit transactions to
the State Board of Equalization’s bank account. These payments must be in the NACHA CCD+ format using the Tax Payment Convention
(TXP) and may only be initiated for the EFT tax payments to the State Board of Equalization provided for by statute.
SIGNATURE
TITLE
DATE
Return to: Board of Equalization, Attn. EFT Group, P.O. Box 942879, Sacramento, CA 94279-0035
or fax to 916-322-8457
For EFT assistance call 916-327-4229
Make a copy for your records.
CLEAR
PRINT
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