Free TC-86, App to Remit Utah Withholding Payments Through EFT ACH Credit - Utah

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Utah State Tax Commission 210 North 1950 West · Salt Lake City, UT 84134 · www.tax.utah.gov

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TC-86
Rev. 12/08

Application to Remit Utah State Withholding Tax Payments Through Electronic Funds Transfer (EFT) ACH Credit

Taxpayers choosing to remit Utah State withholding tax payments using EFT ACH Credit must agree to the terms and conditions set forth below. Complete and sign this application, and submit it to the Tax Commission at the address below.

Company Identification
Company name Address

City Utah withholding tax account number Contact person within the company Telephone number Fax number

State Federal identification number Contact person's title Email address

Zip

Company Authorization and Agreement
The above named taxpayer elects to initiate tax payments to the Utah State Tax Commission using electronic funds transfer through the ACH Credit method. Funds will be electronically remitted from the taxpayer's bank account to the Tax Commission's bank account. The Taxpayer will follow all procedures and will conform to the addendum transfer format and content as specified by the Tax Commission in Pub. 43. All statutes and rules for taxes in the State of Utah shall remain in effect. The taxpayer may terminate this agreement by sending written notice to the Tax Commission's EFT Unit at least 10 days before taxes are due. The signature of the taxpayer or authorized agent on this agreement will be considered to be the signature authorizing each future payment, until changed by the taxpayer or taxpayer's agent.
Authorized signature Title Date

To Request EFT Authorization... · Fill out and sign the application form above. · Mail to the address below or fax to 801-297-3899 Electronic Funds Transfer Unit Utah State Tax Commission 210 North 1950 West Salt Lake City, UT 84134
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