Common Contracts
1 similar Electronic Funds Transfer Authorization Agreement contracts
Robert Sprague Electronic Funds Transfer Authorization AgreementElectronic Funds Transfer Authorization Agreement • March 29th, 2019
PLEASE COMPLETE TAX TYPES LISTED BELOW PART I TAXPAYER INFORMATION Federal ID Number Taxpayer Name Contact Person Mailing Address Telephone Number City, State, Zip Code Fax Number Email Address Part II Tax Type □ New EFT Account □ Modify EFT Account ENTER FEDERAL ID NUMBER □ Insurance # □ IOLTA # □ Motor Vehicle Fuel # □ Public Utilities # PART III ACH DEBIT OPTION (Taxpayer phones in tax payment) Financial Institution Name Type of Account□ Checking □ Savings Transit & Routing Number Bank Account Number I hereby authorize the State of Ohio Treasurer’s Office to process ACH Debit entries from the bank account specified above. This debit will pertain only to Electronic Funds Transfer Payments for the above named taxpayer. Authorized Signature Date PART IV ACH CREDIT OPTION (Taxpayer initiates payment through their bank) I hereby request the State of Ohio Treasurer’s Office to grant authority for the above named taxpayer to initiate ACH Credit Transactions to the State Treasurer’s
