Form Eft - Authorization Agreement For Electronic Funds Transfers Page 2
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1
2
3Instructions for Form EFT
Tax Type: Businesses may use electronic funds
•
Bank address: Indicate the address of the bank
transfers (EFT) to file and pay Maryland withholding,
branch you will be using.
sales and use, motor fuel and corporate income taxes.
•
Bank account number: The account number from
Accepted corporate forms are 500, 500D, 500DP and
which the state will draw debit entries.
500E only. Forms 510, 510D, 510E for Pass-Through
•
Type of account: Check the appropriate box for
Entities NOT accepted.
the type of account (savings or checking) you will
Section A – This section must be completed by
be using for electronic funds transfer.
ALL taxpayers.
•
Bank routing transit number: Your bank’s nine-
•
Business name - required
digit routing/transit number is required.
•
Maryland Central Registration Number - if
•
Signature
of
owner,
partner,
or
officer:
registered
Authorized signature of owner, partner or officer
•
Federal Employer Identification Number -
of the company. This signature will authorize the
required
Comptroller of Maryland to present debit entries.
•
Motor Fuel Tax Account Number - if applicable
Section C – Complete this section only if you are
choosing the ACH Credit option.
•
EFT contact person: The primary contact person
should be someone within your company who will be
Name and address of the bank: Provide the name
directly involved in all phases of the EFT registration
and address of the bank you will be using for electronic
process, system implementation, and the payment
fund transfers.
of the tax. Instructions will be mailed to the contact
Printed name and signature of bank representative
person designated on the agreement. You should
(include bank representative’s telephonenumber): You
also designate a secondary contact person.
cannot use the ACH Credit option unless your bank can
•
Address: Indicate the mailing address to be used
initiate transactions in this format.
for corresponding regarding electronic funds
Mail this completed form to:
transfer.
EFT Program
•
Telephone
number:
Indicate
the
telephone
P.O. Box 1509
number(s) for the EFT contact person.
Annapolis, MD 21404-1509
•
Signature
of
owner,
partner,
or
officer:
Authorized signature of owner, partner, or officer of
the company.
Section B – Complete this section only if you are
choosing the ACH Debit option.
•
Bank name: Name of the bank you will be using for
electronic funds transfers.
EFT Program telephone number 410-260-7980 • Fax: 410-260-6214
Hearing impaired users call via Maryland Relay at 711 in Maryland
COM/RAD-072 Rev. 10-10
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