Form De 26 - Electronic Funds Transfer (Eft) Authorization Agreement
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1Department Use Only
ELECTRONIC FUNDS TRANSFER (EFT)
Check appropriate box:
AUTHORIZATION AGREEMENT
New EFT Account
State Data Collector System
Change Bank Account
(See reverse for instructions.)
Change Contact Information
SECTION I: Employer information must be completed.
Business Name
Employer Account Number
Business Mailing Address (Number, Street, or Box Number)
Business Phone Number
Business Mailing Address (City, State, and ZIP Code)
EFT Contact Person
Contact Phone Number
Fax Number
SECTION II: Bank account information must be completed.
IMPORTANT: Attach a copy of a voided check or bank specification sheet. A form without the attachment
will be returned unprocessed.
Bank Name
Routing Transit Number
Bank Account Number
Checking
Savings
For Bank Account Changes only, complete the following:
The settlement date of your last EFT payment to the 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 III: Authorization Agreement
I hereby authorize designated Financial Agents of the Employment Development Department (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.
Signature
Title
Phone Number
Date
Print Name
Fax the completed form to 916-654-7441, or
Mail to:
e-Pay Unit, MIC 15A
Employment Development Department
P.O. Box 826880
Sacramento, CA 94280-0001
If you have questions regarding this form, please call the e-Pay Unit at 916-654-9130.
DE 26 Rev. 9 (4-13) (INTERNET)
Page 1 of 2
CU
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Parent category: Legal