Form 2328 - Electronic Funds Transfer (Eft) Credit Application - 2012

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Michigan Department of Treasury
Form 2328 (Rev. 03-12)
Electronic Funds Transfer (EFT) Credit Application
Issued under P.A. 122 of 1941. Filing is mandatory if you wish to pay by EFT.
INSTRUCTIONS: Use this form to notify us that you intend to file electronically. You may begin electronic filing after you receive our approval. Voluntary
EFT filers will be required to transmit their tax monthly.
Taxpayer Name (Type or Print)
Taxpayer Identification Number
99
9999999
COMPANY LEGAL NAME
____
Address
State
ZIP code
STATE
ZIP CODE
COMPANY LEGAL ADDRESS, CITY
Contact Person
Contact Person Telephone Number
Contact Person Fax Number
PAYROLL ADMIN
(999) 999-9999
(999) 999-9999
Indicate the type of tax(es) you will be paying by EFT:
Tax Type and Tax Code
X
Witholding - Employer and Retirement (01100)
Corporate Income Tax Estimates (02170)
Michigan Business Tax Extensions (02355)
Corporate Income Tax Extensions (02370)
Michigan Business Tax Annual (02655)
Flow Through Withholding Corporation Quarterly (02010)
Single Business Tax Annual (02671)
Flow Through Withholding Individual Quarterly (02020)
Sales Tax (04200)
Flow Through Withholding Annual (02675)
Use Tax on Sales and Rentals (04400)
Use Tax on Purchases (04500)
The Michigan Department of Treasury will approve requests for EFT Credits if you agree to follow the adopted format. See Form 2329, Instructions for
Payments of Michigan Sales, Use, Withholding, and Michigan Business Taxes Using EFT Credits. We recommend you electronically send a test (zero
dollar or $.01 transmission, completely formatted) before actual filing can begin.
Authorization for EFT Credits
I agree to follow the formats adopted by the Michigan Department of Treasury for sales, use, withholding and Michigan business tax payments. I agree
.
to notify Treasury in advance of any change in my filing method
Signature of Responsible Officer
Title
Date
PRIMARY PRINCIPAL SIGNATURE
TITLE
MM/DD/YYYY
Please be aware of officer, member or partner liability as provided in Michigan Compiled Laws 205.27a(5):
“If a corporation, limited liability company, limited liability partnership, partnership, or limited partnership liable for taxes administered under this
act fails for any reason to file the required returns or pay the tax due, any of its officers, members, managers, or partners who the department
determines, based on either an audit or an investigation, have control or supervision of, or responsibility for, making the returns or payments is
personally liable for the failure.......”
CERTIFICATION
Corporations, partnerships, LLP’s or LLC’s must complete this section before this form can be processed. This officer, member or partner certification
must be resubmitted when there is a change in the individual responsible for filing and/or paying Michigan taxes.
X
Check the appropriate box:
New Application
Recertification - change in individual responsible for Michigan taxes
Signature of Corporate Officer, Partner, or Member responsible for reporting and/or paying Michigan Taxes
Date
MM/DD/YYYY
PRIMARY PRINCIPAL SIGNATURE
Type or Print
Title
TITLE
PRIMARY PRINCIPAL NAME
All information requested above must be complete and accurate before your application is processed. Mail or fax the completed application to the
Michigan Department of Treasury for approval. Once approved, you will receive instructions for remitting electronic payments. Please allow 4 weeks for
processing.
TREASURY USE ONLY
Treasury Approval
Date
If you have any questions, contact the Michigan Department of Treasury at (517) 636-4730. You may fax this form to (517) 636-4356, or mail this form to:
Michigan Department of Treasury
Sales, Use and Withholding Taxes
P.O. Box 30427
Lansing, MI 48909

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