Form 9779 - Eftps Business Enrollment
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1
2Electronic Federal Tax Payment System
OMB Number
Business Enrollment
1545-1467
Department of the Treasury - Internal Revenue Service
When your form is completed, please mail to:
Visit EFTPS.gov to enroll online.
EFTPS Enrollment Processing Center
24 hours a day, 7 days a week.
P.O. Box 173788, Denver, CO 80217-3788
You will receive the information you need to use EFTPS within seven business days after we receive your enrollment
form. Enrolling online via EFTPS.gov saves on mail time; consider enrolling that way.
1.
Employer Identification Number (EIN).
Note: If you are a Sole Proprietor business, without employees, you need to enroll as an Individual (Form 9783, EFTPS Individual
Enrollment) and use the primary Social Security Number as your Taxpayer Identification Number.
2-3. Business name; Mailing address. Print this information exactly as it appears on the tax return. A sole proprietorship should use
the owner’s name rather than the DBA name. The only valid characters are A-Z, 0-9, -, &, and blank.
4.
Primary contact name. Print the name of the person, company, or third party to contact if questions arise. All EFTPS mailings will
be sent to the primary contact.
5-6. Primary contact mailing address (if different from item 3 above) and Primary contact phone number. If an address is
provided here, it will be used to mail confirmation materials.
7.
Payment method. Note: If you wish to use multiple accounts in one financial institution or accounts in multiple financial
institutions, you will need to complete a separate form for each enrollment.
Example
Use black or blue ink only.
Print legibly.
CEDAR RAPIDS
IA
52471
Use only CAPITAL letters.
City
State
ZIP Code
Business Information
1. Employer Identification Number (EIN)
2. Business name
3. Mailing address
City
State
ZIP code
International (Provide Province, Country, and Postal code)
Contact Information
4. Primary contact name
5. Primary contact mailing address (if different from item 3 above)
City
State
ZIP code
International (Provide Province, Country, and Postal code)
6. Primary contact phone number (provide only one)
US number
International number
Payment Information
7. Payment method
Authorize a transaction yourself: free — most frequently used by small businesses and individuals.
Have your financial institution initiate your transaction: check with your financial institution first to see if this service is available and
what fees you may be charged.
9779
Catalog Number 21816U
Form
(Rev. 12-2011)
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