Form Eft-001 - Electronic Funds Transfer Authorization Agreement For Ach Debit Payment Method

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Form EFT-001 ACH Debit Method Instructions
This form is for taxpayers who pay via ACH Credit Method who
wish to change to ACH Debit Method
NOTE: Non-ACH Credit Method payers can pay online via Debit Method without pre-registration.
ACH Credit Method payers must complete the following information to change to
ACH Debit Method:
Taxpayer’s Name/Address:
State the legal name of applicant, and the mailing address of the applicant.
Tax Type:
State the type of tax you are reporting. For example: Sales Tax, Sellers Use Tax, Consumers Use
Tax, Rental Tax, Local Sales/Use Taxes, Utility Tax, Withholding Tax, Corporate Income Tax,
Business Privilege, Tobacco Tax, Oil & Gas Severance Tax, etc.
Tax Account Number:
State the tax account number used to report the tax type as specified above. For example: Sales
Tax Account
Number 5100 12345; Sellers Use Tax Account Number 68SU-12345; Rental Tax Account
Number 7668-12345;
Local Sales/Use Tax Account Number 9501012345; Withholding Tax Account Number
0000123456; Corporate
Income Tax Account Number 12-3456789. Do NOT enter your Social Security Number.
Contact Person/Title/Phone/Fax/Email/Address:
The EFT contact person is the individual whom the Alabama Department of Revenue will contact
if there is a question concerning an EFT payment made by the taxpayer. Any correspondence
concerning the Alabama EFT Tax Payment Program will be directed to your designated EFT
contact person.
Signature:
The EFT Authorization Form must be signed by the owner or an officer of the company
requesting the ACH Debit Payment method.
_____________________________
For additional information pertaining to the EFT Payment Program, please visit our Web
site at
or call 1-800-322-4106, option 7
for a representative.

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