Instatax Sign Up Application - Union Bank
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1INSTATAX
SIGN UP APPLICATION
®
Client Information
LEGAL NAME (As shown on your tax return)
DBA NAME (If applicable)
ADDRESS
CITY
STATE
ZIP CODE
TELEPHONE NUMBER
EXT.
PRIMARY CONTACT NAME
FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)
BANK ACCOUNT NUMBER*
BANK ACCOUNT NAME
*NOTE: This is the account to which InstaTax transactions and services fees are processed.
Receipt and Report (Optional)
RECEIPT OPTION (check one):
Mail
Fax -- If Fax, enter Fax number:________________________
No Receipt
MONTHLY RECAP REPORT:
NO (Default)
Yes
QUARTERLY RECAP REPORT (optional):
No (Default)
Yes
Enroll me for Federal payments only
• For all Federal and State payments: RAAF (Reporting Agency
Enroll me for Federal and State payments (list State
Authorization Form, IRS Form 8655) must be completed
agencies and ID’s below)
• For all State payments: you must enroll with the State agency’s
Enroll me for State payments only (list State agencies
Electronic Funds Transfer (EFT) program prior to using Instatax.
and ID’s below)
California State Tax Types
Other State Tax Types
TAX AGENCY
TAX AGENCY
STATE
STATE ID NUMBER
STATE
STATE ID NUMBER
NAME
NAME
CA
BOE
CA
CDI
CA
EDD
FTB ID No. = Entity (7 Characters) + Posting Control (5
CA
FTB
characters)
Authorization and Agreement
Each of the undersigned is a duly authorized representative of the
Each of the undersigned warrants that the Client has taken all action
business organization specified below (the “Client”), applying for
required by its organizational or constituent documents to authorize
InstaTax (the “Service”) and authorizes Union Bank of California, N.A.
each of the undersigned to execute and deliver on behalf of the Client
(“Bank”) to provide the Service to the Client’s account designated
this Authorization and Agreement form and any other documents the
above (“Account”). The Client understands and agrees that the use of
Bank may require with respect to the Service. Each of the undersigned
the Service is subject to the terms and conditions contained in the All
is authorized to enter into all transactions contemplated by the
About Business Accounts & Services disclosure and Agreement
provision of the Service to the Client. These may include, but are not
booklet which the Bank gave the Client when it opened its Account(s).
limited to, giving the Bank instructions with regard to Funds Transfer
Services and designating employees or agents to act in the name and
Client agrees that it is solely responsible for the selection, installation,
on behalf of the Client.
maintenance, operation and cost of any necessary computer,
software and Internet service provider that may be required for use
with the Service.
Print Name of Organization
Signature of Authorized Signer
Date
Signature of Authorized Signer
Date
Name of Authorized Signer (Print)
Name of Authorized Signer (Print)
Title (Print)
Title (Print)
FOR BANK USE ONLY (ACCOUNT OFFICER INFORMATION)
DATE ACCEPTED BY ACCT OFFICER
ACCT OFFICE EMP. NO.
ACCT OFFICER NAME
BRANCH NO.
BRANCH NAME
FORM 02451 (Rev, 02/2007)
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