Form Boe-555-Eft - Authorization Agreement For Electronic Funds Transfer (Eft) Page 2

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BOE-555-EFT (BACK) REV. 6 (4-06)

Instructions for Completing the EFT Authorization Agreement Form

General

Please type or print clearly. Return to the State Board of Equalization within ten days from the date received. Make a copy for your records.

Section I

Complete all blocks in this section. Your BOE account number is required (for example, 30-123456).

Sections II and III

Complete and sign one of these sections, not both.

Complete Section II if you select ACH Debit, or Section III if you select ACH Credit. After making your decision, please check the appropriate

box and complete every block of information for the method selected.

If the ACH Debit method is chosen, a voided check must be attached to the completed form. Your voided check will verify bank account and

routing numbers.

The example of a voided check, shown below, indicates where to locate the routing number for your bank and your bank account number.

Remember to mark the word “void” across the face of the check that you return with the authorization agreement.

Routing Number

(requires 9 digits)

Bank Account Number

(not to exceed 17 digits)

Check Number

Important Information

EFT Start Date for New Accounts

You will be notified in writing if your agreement is approved. Your confirmation letter will indicate when you must start making EFT payments. DO NOT attempt

to pay by EFT before your approved start date.

Withdrawal Information

Once you are registered, you cannot withdraw from the EFT program unless your average monthly tax, over a twelve-month period, is less than $10,000.

If you qualify and wish to withdraw, you must make your request in writing (this is not true if you are closing out your account). Send your letter to EFT Group,

P.O. Box 942879, Sacramento, CA 94279-0035. You must continue to make payments by EFT until the Board notifies you in writing that your request has

been approved and indicates the ending date for making EFT payments.

Changing Your Payment Method (ACH Debit vs. ACH Credit)

If you are submitting an authorization agreement form to change from ACH Debit to ACH Credit, or vice versa, you must continue to use your current report-

ing method until you are notified in writing by the Board that your request has been approved. A confirmation letter will be mailed to you once your method

of payment has been changed.

New Bank Account or Routing Number

If you are submitting an authorization agreement form to change your bank account or routing number, you will not receive a confirmation letter.