Form Dr-600 - Enrollment And Authorization For E-Services

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DR-600
Enrollment and Authorization for e-Services
R. 01/15
TC
This form can be completed online
To enroll for multiple taxes or fees, you must
Rule 12-24.011
Florida Administrative Code
at
use a separate form for each tax or fee or
Effective 01/15
you can enroll online all at once.
Section 1 – Check the Box That Applies
Initial enrollment
Change in filing/ payment method
Bank change
Contact information change
Complete all sections
Complete sections 2, 4, 5, and 6
Complete sections 2, 5, and 6
Complete sections 2, 3, & 6
If you wish to enroll for multiple taxes or accounts, you must use a separate form for each one or enroll online using our Internet site. The online
application allows you to enroll for all taxes at one time.
Section 2 – Business Information
Business entity name
Type of tax (Note: Only 1 tax type per form)
FEIN/SSN*
Tax account/certificate number (if different from FEIN/SSN)
*Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identifiers for the administration of Florida’s taxes. SSNs obtained for tax
administration purposes are confidential under sections 213.053 and 119.071, Florida Statutes, and not subject to disclosure as public records. Collection of your SSN
is authorized under state and federal law. Visit our Internet site at and select “Privacy Notice” for more information regarding the state and
Federal law governing the collection, use, or release of SSNs, including authorized exceptions.
Section 3 – Contact Information
Electronic Payment Contact Person’s Information
Electronic Return Contact Person’s Information
Name
Name
Mailing address
Mailing address
City/State/ZIP
City/State/ZIP
Telephone number (include area code)
Fax number (include area code)
Telephone number (include area code)
Fax number (include area code)
E-mail address
E-mail address
Contact is a:
company employee
non-related tax preparer
Contact is a:
company employee
non-related tax preparer
If tax preparer, provide Preparer Taxpayer Identification Number (PTIN):
If tax preparer, provide Preparer Taxpayer Identification Number (PTIN):
If reemployment (RT) agent, provide RT Agent Number
If reemployment (RT) agent, provide RT Agent Number
Section 4 – Filing/Payment Method Selection and Descriptions
ACH–Debit (e-check) is the action taken when the Department’s bank withdraws a tax payment from the taxpayer’s bank account upon payers
request; the taxpayer’s account is debited.
ACH–Credit is the action taken when the taxpayer’s bank transfers a tax payment to the Department’s bank account; the Department’s account is
credited. This is not a credit card payment.
Electronically File
Electronically Pay (select one):
ACH Debit (e-check)
ACH Credit
Section 5 – Banking Information (not required for ACH-Credit)
Bank Name _________________________________________
ABA Routing/Transit No.
Bank Account No. ___________________________________
Account Type
Business Checking
Personal Checking
Business Savings
Personal Savings
Note: Due to federal security requirements, we cannot process international ACH transactions. If any portion of the money used in
payments you will make will come from financial institutions located outside of the US or its territories for the purpose of funding these
payments, please contact us to make other payment arrangements. If you are unsure, please contact your financial institution.

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