Form 2328 - Electronic Funds Transfer (Eft) Credit Application

Michigan Department of Treasury

Form 2328 (Rev. 03-12)

Electronic Funds Transfer (EFT) Credit Application

Issued under P.A. 122 of 1941. Filing is mandatory if you wish to pay by EFT.

INSTRUCTIONS: Use this form to notify us that you intend to file electronically. You may begin electronic filing after you receive our approval. Voluntary

EFT filers will be required to transmit their tax monthly.

Taxpayer Name (Type or Print)

Taxpayer Identification Number

9999999

COMPANY LEGAL NAME

____

Address

State

ZIP code

STATE

ZIP CODE

COMPANY LEGAL ADDRESS, CITY

Contact Person

Contact Person Telephone Number

Contact Person Fax Number

PAYROLL ADMIN

(999) 999-9999

Indicate the type of tax(es) you will be paying by EFT:

Tax Type and Tax Code

Witholding - Employer and Retirement (01100)

Corporate Income Tax Estimates (02170)

Michigan Business Tax Extensions (02355)

Corporate Income Tax Extensions (02370)

Michigan Business Tax Annual (02655)

Flow Through Withholding Corporation Quarterly (02010)

Single Business Tax Annual (02671)

Flow Through Withholding Individual Quarterly (02020)

Sales Tax (04200)

Flow Through Withholding Annual (02675)

Use Tax on Sales and Rentals (04400)

Use Tax on Purchases (04500)

The Michigan Department of Treasury will approve requests for EFT Credits if you agree to follow the adopted format. See Form 2329, Instructions for

Payments of Michigan Sales, Use, Withholding, and Michigan Business Taxes Using EFT Credits. We recommend you electronically send a test (zero

dollar or $.01 transmission, completely formatted) before actual filing can begin.

Authorization for EFT Credits

I agree to follow the formats adopted by the Michigan Department of Treasury for sales, use, withholding and Michigan business tax payments. I agree

to notify Treasury in advance of any change in my filing method

Signature of Responsible Officer

Title

Date

PRIMARY PRINCIPAL SIGNATURE

TITLE

MM/DD/YYYY

Please be aware of officer, member or partner liability as provided in Michigan Compiled Laws 205.27a(5):

“If a corporation, limited liability company, limited liability partnership, partnership, or limited partnership liable for taxes administered under this

act fails for any reason to file the required returns or pay the tax due, any of its officers, members, managers, or partners who the department

determines, based on either an audit or an investigation, have control or supervision of, or responsibility for, making the returns or payments is

personally liable for the failure.......”

CERTIFICATION

Corporations, partnerships, LLP’s or LLC’s must complete this section before this form can be processed. This officer, member or partner certification

must be resubmitted when there is a change in the individual responsible for filing and/or paying Michigan taxes.

Check the appropriate box:

New Application

Recertification - change in individual responsible for Michigan taxes

Signature of Corporate Officer, Partner, or Member responsible for reporting and/or paying Michigan Taxes

Date

MM/DD/YYYY

PRIMARY PRINCIPAL SIGNATURE

Type or Print

Title

TITLE

PRIMARY PRINCIPAL NAME

All information requested above must be complete and accurate before your application is processed. Mail or fax the completed application to the

Michigan Department of Treasury for approval. Once approved, you will receive instructions for remitting electronic payments. Please allow 4 weeks for

processing.

TREASURY USE ONLY

Treasury Approval

Date

If you have any questions, contact the Michigan Department of Treasury at (517) 636-4730. You may fax this form to (517) 636-4356, or mail this form to:

Michigan Department of Treasury

Sales, Use and Withholding Taxes

P.O. Box 30427

Lansing, MI 48909