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

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BOE-555-ST (BACK) REV. 7 (10-10)
Instructions for Completing the EFT Authorization Agreement Form
General
Please type or print clearly and return this form to the BOE promptly. Be sure to make a copy for your records.
Section I
Complete all blocks in this section. Your BOE account number is required, for example (044-123456).
Sections II and III
Complete 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 this 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.
Important Information
1. 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.
2. Withdrawal Information
Once you are registered, you cannot withdraw from the EFT program unless your average monthly tax, over a 12-month
period, is less than $20,000. If you qualify and wish to withdraw, you must make your request in writing. You must continue to
make payments by EFT until the BOE notifies you in writing that your request has been approved and indicates the ending
date for making EFT payments.
3. 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 reporting method until you are notified in writing by the BOE that your request has been approved.
A confirmation letter will be mailed to you once your method of payment has been changed.
4. 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.

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