Form Dr-600 - Enrollment And Authorization For E-Services (Page 2 of 2) in pdf

Form Dr-600 - Enrollment And Authorization For E-Services Page 2

Section 6 – Enrollee Authorization and Agreement

This is an Agreement between the Florida Department of Revenue, hereinafter “the Department,” and the business entity named herein,

hereinafter “the Enrollee,” entered into according to the provisions of the Florida Statutes and the Florida Administrative Code.

By completing this agreement and submitting this enrollment request, the Enrollee applies and is hereby authorized by the Department to file

tax returns and reports, make tax and fee payments, and transmit remittances to the Department electronically. This agreement represents

the entire understanding of the parties in relation to the electronic filing of returns, reports, and remittances.

The same statute and rule sections that pertain to all paper documents filed or payments made by the Enrollee also govern an electronic

return, or payment initiated electronically according to this enrollment.

I certify that I am authorized to sign on behalf of the business entity identified herein, and that all information provided in this document

has been personally reviewed by me and the facts stated in it are true. According to the payment method selected, I hereby authorize the

Department to present debit entries into the bank account referenced at the depository designated herein (ACH-Debit), or I am authorized to

register for the ACH-Credit payment privilege and accept all responsibility for the filing of payments through the ACH-Credit method.

_________________________________________________________________

______________________________

_____________________________

Signature

Title

Date

_________________________________________________________________

______________________________

Print Name

Telephone Number

_________________________________________________________________

______________________________

_____________________________

Second signature (if dual signature account)

Title

Date

Most change/update requests can be made online if you are already enrolled and have your user information.

or, Complete and mail this form to:

Enroll online at

Account Management Mail Stop 1-5730

Call for assistance:

Florida Department of Revenue

5050 W Tennessee St

800-352-3671

Tallahassee, FL 32399-0160

Fax 850-488-5997

Form Dr-600 - Enrollment And Authorization For E-Services Page 2