Form De 26 - Electronic Funds Transfer (Eft) Authorization Agreement
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1Department Use Only
Location
ELECTRONIC FUNDS TRANSFER (EFT)
Registration Date
AUTHORIZATION AGREEMENT
See reverse for instructions on how to complete the form
SECTION I: This form is for businesses who would like to use the Employment Development Department’s (EDD)
Interactive Voice Response (IVR) telephone system to make EFT payments and for current ACH Debit filers and EFT
Bulk Filers using the ACH Debit Method provided through Fidelity National Information Services (FIS), formerly
Metavante. Please check the appropriate box(es) below:
I am registering to make payments using EDD’s IVR System.
I am currently an ACH Debit Filer or an ACH Debit Bulk Filer.
I am changing the bank account from which EFT ACH Debit entries will be made.
SECTION II: ALL ITEMS MUST BE COMPLETED.
A. Business Name
B. Employer Account Number
C. Business Address (Number, Street, Box Number, City, State, ZIP Code)
D. Business Phone
(
)
E. EFT Contact Person
Title
Telephone Number
(
)
Fax Number
(
)
E-Mail Address
SECTION III:
IMPORTANT: ATTACH A VOIDED PRE-PRINTED CHECK OR BANK SPECIFICATION SHEET WITH THIS FORM.
A. Bank Name
B. Routing Transit Number
C. Bank Account Number
D. Checking or Savings Account?
Checking
Savings
E. For Bank Account Changes Only. Complete the following and attach a voided pre-printed check or bank
specification sheet.
The settlement date of your last EFT payment to EDD was
The due date of your next EFT payment is
Will your old and new bank accounts be open with funds available until completion of this bank change?
Yes
No
SECTION IV: Authorization
Please read the following Authorization Agreement:
I hereby authorize designated Financial Agents of the EDD to initiate debit entries to the financial institution account indicated above,
for payments owed to the EDD upon request by taxpayer or his/her representative, using the ACH Debit Method.
A. Signature
B. Title
C. Phone Number
D. Date
(Owner, Accountant, Preparer, etc.)
(
)
Fax the completed form to (916) 654-7441 or
Mail to:
EFT Unit MIC 15A
Employment Development Department
P.O. Box 826880
Sacramento, CA 94280-0001
For questions about this form, please call the EFT Helpline at (916) 654-9130.
DE 26 Rev. 7 (12-10) (INTERNET)
Page 1 of 2
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Parent category: Legal