Form 112-Ep - Corporate Estimated Tax Payment Voucher - 2003

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DO YOU WANT TO AVOID MAILING THESE FORMS?
If so, file and pay your estimated income taxes electronically using the ACH debit method. With one phone call, you can pay your estimated tax without
writing a check, or mailing anything. When it is time to pay estimated tax, you dial a toll-free number; enter your EFT authorization number, a password,
tax type codes, filing period, and dollar amount. The next day, the money will be transferred to the Department of Revenue and credited to your account.
If you currently use ACH credits for payments you may make estimated income tax payment to the Department of Revenue that way as well.
To sign up, fill out the information below and send it to
Colorado Department of Revenue
Denver, CO 80261-0005
Sample Check:
EFT AUTHORIZATION
DR 5778 (06/02)
EFT Number
COLORADO DEPARTMENT OF REVENUE
CORPORATE ESTIMATED INCOME TAX
DENVER CO 80261-0005
3 7 1 0
(303) 866-2388
___ ___ ___ ___ ___ ___ ___ ___ ___ ___
ACH DEBIT
To be assigned by Department of Revenue
Taxpayer Name
Colorado Account Number
Mailing Address
Federal Employer Identification Number (FEIN)
01212
City
State
ZIP
Contact Person
Phone
(
)
I authorize the Colorado Department of Revenue,
persuant to my instructions, to initiate entries to my account number ________________________ at __________________________________ bank.
Name of Bank Account
Type of Account
Checking
Savings
Bank Transit/Routing Number
Signature
ATTACH A VOIDED CHECK FOR THE BANK ACCOUNT INDICATED ABOVE
DR 5778A (06/02)
EFT AUTHORIZATION
EFT Number
COLORADO DEPARTMENT OF REVENUE
CORPORATE ESTIMATED INCOME TAX
DENVER CO 80261-0005
3 7 1 0
(303) 866-2388
___ ___ ___ ___ ___ ___ ___ ___ ___ ___
ACH CREDIT
To be assigned by Department of Revenue
Taxpayer Name
Colorado Account Number
Mailing Address
Federal Employer Identification Number (FEIN)
01212
City
State
ZIP
Contact Person
Phone
(
)
I hereby request the Colorado Department of Revenue (DOR) grant authority for the taxpayer to initiate Automated Clearing House credit
transactions to DOR's bank account. I understand these must be in the NACHA CCD+ format using the TXP addendum record format.
Signature
Date

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