Free BOE-555-EFT Authorization Agreement for Electronic Funds Transfer (EFT) - California

BOE-555-EFT (FRONT) REV. 6 (4-06)

STATE OF CALIFORNIA

AUTHORIZATION AGREEMENT FOR ELECTRONIC FUNDS TRANSFER (EFT)

BOARD OF EQUALIZATION

Please Check Appropriate Boxes:
See reverse for instructions.
(Type or Print in Ink)

New EFT account Change EFT reporting method Change bank account on
(date)

Change contact name or phone number

SECTION I
TAXPAYER NAME BOE ACCOUNT NUMBER

DBA (doing business as)

BUSINESS PHONE NUMBER

(
CONTACT PERSON

) )

-- --

CONTACT PHONE NUMBER

(

Complete and sign either Section II or III below (not both) SECTION II



ACH Debit

The State Board of Equalization is hereby authorized to initiate debit entries to the bank account identified below and the bank is authorized to debit such account. This authority is to remain in full force until EFT payments are no longer required by statute or, if I am a voluntary participant, until the State Board of Equalization and I mutually agree to terminate my participation in the EFT program.
BANK NAME

TYPE OF ACCOUNT
BANK ACCOUNT NUMBER (not to exceed 17 digits)

Checking Savings
TITLE DATE

ROUTING NUMBER:
SIGNATURE

IMPORTANT: If you have selected the ACH Debit option, you must attach a voided check for the account to be debited. Your voided check will verify bank account and routing numbers. If you are unable to provide a voided check, a bank specification sheet may be used instead of the voided check.

SECTION III (Do not complete if you have completed Section II above.)

ACH Credit
The State Board of Equalization is hereby requested to grant authority for the abovenamed taxpayer to initiate ACH credit transactions to the State Board of Equalization's bank account. These payments must be in the NACHA CCD+ format using the Tax Payment Convention (TXP) and may only be initiated for the EFT tax payments to the State Board of Equalization provided for by statute.
SIGNATURE TITLE DATE

Return to: Board of Equalization, Attn. EFT Group, P.O. Box 942879, Sacramento, CA 94279-0035 or fax to 916-322-8457 For EFT assistance call 916-327-4229 Make a copy for your records.
CLEAR PRINT

BOE-555-EFT (BACK) REV. 6 (4-06)

Instructions for Completing the EFT Authorization Agreement Form General
Please type or print clearly. Return to the State Board of Equalization within ten days from the date received. Make a copy for your records.

Section I
Complete all blocks in this section. Your BOE account number is required (for example, 30-123456).

Sections II and III
Complete and sign one of these sections, not both. Complete Section II if you select ACH Debit, or Section III if you select ACH Credit. After making your decision, please check the appropriate box and complete every block of information for the method selected. If the ACH Debit method is chosen, a voided check must be attached to the completed form. Your voided check will verify bank account and routing numbers. The example of a voided check, shown below, indicates where to locate the routing number for your bank and your bank account number. Remember to mark the word "void" across the face of the check that you return with the authorization agreement.

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Routing Number (requires 9 digits) Bank Account Number (not to exceed 17 digits) Check Number

Important Information
1. EFT Start Date for New Accounts You will be notified in writing if your agreement is approved. Your confirmation letter will indicate when you must start making EFT payments. DO NOT attempt to pay by EFT before your approved start date. Withdrawal Information Once you are registered, you cannot withdraw from the EFT program unless your average monthly tax, over a twelve-month period, is less than $10,000. If you qualify and wish to withdraw, you must make your request in writing (this is not true if you are closing out your account). Send your letter to EFT Group, P.O. Box 942879, Sacramento, CA 94279-0035. You must continue to make payments by EFT until the Board notifies you in writing that your request has been approved and indicates the ending date for making EFT payments. Changing Your Payment Method (ACH Debit vs. ACH Credit) If you are submitting an authorization agreement form to change from ACH Debit to ACH Credit, or vice versa, you must continue to use your current reporting method until you are notified in writing by the Board that your request has been approved. A confirmation letter will be mailed to you once your method of payment has been changed. New Bank Account or Routing Number If you are submitting an authorization agreement form to change your bank account or routing number, you will not receive a confirmation letter.

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