Form Boe-555-St - Authorization Agreement For Electronic Funds Transfer (Eft)
Download a blank fillable Form Boe-555-St - Authorization Agreement For Electronic Funds Transfer (Eft) in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Boe-555-St - Authorization Agreement For Electronic Funds Transfer (Eft) with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2BOE-555-ST (FRONT) REV. 7 (10-10)
STATE OF CALIFORNIA
AUTHORIZATION AGREEMENT FOR
BOARD OF EQUALIZATION
ELECTRONIC FUNDS TRANSFER (EFT)
New EFT account
Please check appropriate boxes:
Change EFT reporting method
Change bank account on
(date)
Change contact name or phone number
See reverse for instructions on completing this authorization agreement.
(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 Section II or III below (not both):
SECTION II
ACH Debit
The Board of Equalization (BOE) 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 BOE and I mutually agree to terminate my voluntary participation in the EFT program.
BANK NAME
BANK ACCOUNT NUMBER (not to exceed 17 digits)
Type of Account
Checking
ROUTING NUMBER
Savings
SIGNATURE OF TAXPAYER OR AUTHORIZED REPRESENTATIVE
TITLE OF SIGNER
DATE
PRINT NAME OF SIGNER AND CAPACITY IN WHICH SIGNED
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
ACH Credit
The BOE is hereby requested to grant authority for the above-named taxpayer to initiate ACH credit transactions to the BOE’s bank account.
These payments must be in the NACHA CCD+ format using the Tax Payment Convention (TXP) and may only be initiated for EFT tax
payments to the BOE provided for by statute.
SIGNATURE OF TAXPAYER OR AUTHORIZED REPRESENTATIVE
TITLE OF SIGNER
DATE
PRINT NAME OF SIGNER AND CAPACITY IN WHICH SIGNED
Return this form to the State Board of Equalization, Special Taxes and Fees, P.O. Box 942879, Sacramento, CA 94279-0088.
For EFT assistance, please call 800-400-7115 (TDD/TTY: 800-735-2929).
Make a copy for your records.
CLEAR
PRINT
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Boe-555-st - Authorization Agreement For Electronic Funds Transfer (eft) - State Of California
Business
Form R-20193-l - Authorization Agreement For Electronic Funds Transfer (eft) Of Tax Payment Form 1999
Financial
Form 27d - Payment And Authorization Agreement For Electronic Funds Transfer (eft) Of Tax Payments
Financial
Form 27d - Payment And Authorization Agreement For Electronic Funds Transfer (eft) Of Tax Payments
Financial
Form 27d - Payment And Authorization Agreement For Electronic Funds Transfer (eft) Of Tax Payments
Financial
Form 27d - Payment And Authorization Agreement For Electronic Funds Transfer (eft) Of Tax Payments - 1996
Financial
Related Categories
Parent category: Financial