Epay Authorization Enrollment Form printable pdf download

Epay Authorization Enrollment Form

e-pay is easy!

E‐Pay Authorization Enrollment Form

For your convenience, Payyournanny.com is pleased to offer this electronic tax payment service.

Clients will no longer need to print, sign, and mail payroll tax returns and payments. With E‐Pay, taxes can be automatically

withdrawn from your bank account on a quarterly or monthly basis; depending on filing frequency assigned by your state.

Payyournanny.com will continue to calculate the tax liability, and will schedule your payments. Electronic confirmations will be

emailed to clients, reflecting the date and dollar amount of the scheduled debit transaction(s).

Please provide the following information to authorize Payyournanny.com to file and pay the state withholding and

unemployment returns electronically.

Name: ______________________________________________________________________

Address: _____________________________________________________________________

Phone Number: ____________________________

Email Address: _____________________________

Required Banking Information:

Name of Banking Institution: ____________________________________________

Bank Routing #: ________________________________________

Bank Account #: ________________________________________

Type of Account: Checking or Savings

(circle one)

Please attach a voided check and mail this form with the one‐time E‐Pay Set‐up Fee of $45.00 to:

Payyournanny.com

Attn: Barbara Yudd

24236 Knollbrook Pl

Aldie, VA 20105

I authorize Payyournanny.com to electronically schedule payment for State withholding and unemployment

insurance liabilities; and year‐end W‐2 transmission. I am responsible for funding the bank account above to

ensure tax payments will be paid in a timely manner.

Client Signature: _____________________________________ Date: ___________

Note: Payyournanny.com maintains all client information in the strictest of confidence and does not share secure client

information under any circumstances.

Epay Authorization Enrollment Form