Form DR 5785 Electronic Funds Transfer (Eft) Account Setup for Tax Payments - Colorado

Form DR5785 or the "Electronic Funds Transfer (eft) Account Setup For Tax Payments" is a form issued by the Colorado Department of Revenue.

The form was last revised in July 2, 2018 and is available for digital filing. Download an up-to-date Form DR5785 in PDF-format down below or look it up on the Colorado Department of Revenue Forms website.

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DR 5785 (07/02/18)
COLORADO DEPARTMENT OF REVENUE
Pierce Cashiers Room 132
P.O. Box 173350
Denver, CO 80217-3350
EFT Number
Electronic Funds Transfer (EFT)
Account Setup For Tax Payments
To be assigned by Department of Revenue
Taxpayer Name
Contact Person
Set Up New Account
Mailing Address (Street Number, Apt. Number, Box Number)
FEIN or Social Security Number
Modify Account
Telephone Number
Add Taxes
City, State, ZIP
Fax Number
Remove Taxes
Email Address
Add Additional EFT Number(s)
Tax To Be Paid by EFT Transactions.
Must be completed for either ACH debit or ACH credit.
See listing of taxes and tax type codes on reverse side.
Tax Type
Tax Type Code
Your DOR Account
Complete Section 1 and/or 2
Section 1—ACH Debit
ACH Debit—taxpayer selects the EFT payment option on our web page or calls a toll free number
I hereby authorize the Colorado Department of Revenue (DOR), to initiate debit entries to my banking account. This
authority is to remain in full force and effect until DOR and Financial Institution have received written notification
from me of its termination in such time and in such manner as to afford DOR and FI a reasonable time to act
on it. The use of an EFT identification number and password will be required to convey my instructions for each
transaction. The EFT identification number and password may be used by me or by my agent. You will be able to
provide your banking information 24 hours after your registration for EFT.
Authorized Signature
Title
Date
(MM/DD/YY)
Section 2—ACH Credit
ACH Credit—taxpayer initiates through own financial institution.
I have contacted my financial institution and confirmed the financial institution can initiate Automated Clearing House
credit transactions that meet Colorado Department of Revenue (DOR) requirements. For verification, DOR may contact:
Name of Bank
Bank Contact Person
Telephone Number
I hereby request DOR grant authority for the above named 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 Tax Payment
(TXP) Convention or the Third Party Payment (TPP) Convention. May only be initiated for the tax types that have
been registered for EFT payments with DOR.
Authorized Signature
Title
Date
(MM/DD/YY)
Please return application to: Colorado Department of Revenue, P.O. Box 173350, Denver CO 80217-3350
or fax to (303) 205-5779.
DR 5785 (07/02/18)
COLORADO DEPARTMENT OF REVENUE
Pierce Cashiers Room 132
P.O. Box 173350
Denver, CO 80217-3350
EFT Number
Electronic Funds Transfer (EFT)
Account Setup For Tax Payments
To be assigned by Department of Revenue
Taxpayer Name
Contact Person
Set Up New Account
Mailing Address (Street Number, Apt. Number, Box Number)
FEIN or Social Security Number
Modify Account
Telephone Number
Add Taxes
City, State, ZIP
Fax Number
Remove Taxes
Email Address
Add Additional EFT Number(s)
Tax To Be Paid by EFT Transactions.
Must be completed for either ACH debit or ACH credit.
See listing of taxes and tax type codes on reverse side.
Tax Type
Tax Type Code
Your DOR Account
Complete Section 1 and/or 2
Section 1—ACH Debit
ACH Debit—taxpayer selects the EFT payment option on our web page or calls a toll free number
I hereby authorize the Colorado Department of Revenue (DOR), to initiate debit entries to my banking account. This
authority is to remain in full force and effect until DOR and Financial Institution have received written notification
from me of its termination in such time and in such manner as to afford DOR and FI a reasonable time to act
on it. The use of an EFT identification number and password will be required to convey my instructions for each
transaction. The EFT identification number and password may be used by me or by my agent. You will be able to
provide your banking information 24 hours after your registration for EFT.
Authorized Signature
Title
Date
(MM/DD/YY)
Section 2—ACH Credit
ACH Credit—taxpayer initiates through own financial institution.
I have contacted my financial institution and confirmed the financial institution can initiate Automated Clearing House
credit transactions that meet Colorado Department of Revenue (DOR) requirements. For verification, DOR may contact:
Name of Bank
Bank Contact Person
Telephone Number
I hereby request DOR grant authority for the above named 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 Tax Payment
(TXP) Convention or the Third Party Payment (TPP) Convention. May only be initiated for the tax types that have
been registered for EFT payments with DOR.
Authorized Signature
Title
Date
(MM/DD/YY)
Please return application to: Colorado Department of Revenue, P.O. Box 173350, Denver CO 80217-3350
or fax to (303) 205-5779.
Addendum To Authorization Agreement For Electronic Funds Transfer (EFT) For
Tax Payments a Separate Tax Return Must be Filed For Most Tax Payments
Tax Type Description
Code
Tax Type Description
Code
Delinquency/Bill Payment:
Individual Estimated*
01204
TPP Addenda Garnishment*
209
Individual Extension*
01404
(ACH Credit only)
Individual Income Bill*
210
Pass-Through Entity
01320
Severance Bill*
08405
Pass-Through Entity Estimated*
01220
Severance Withholding Bill*
01185
Pass-Through Entity Extension*
01420
Excise:
Wage Withholding*
011
Cigarette
072
Wage Withholding Annual Reconciliation
01102
Fuel Distributors
052
1099 Withholding*
01105
IFTA
059
1099 Withholding Annual Reconciliation
01106
IRP Registration
102
Wage Withholding Bill Payment
01130
Sales:
Liquor Excise
065
Marijuana Excise
180
Aviation Fuel Consumer Use
05430
Passenger Mile
0532
Aviation Fuel Retailer’s Use
05420
PUC Fixed Utility Fees*
204
Aviation Fuel Sales
054
Tobacco Products
073
Consumer Use - Business
045
Winery Direct Shipper
06510
County Lodging
074
Fees:
Local Marketing District
04810
Prepaid Wireless E911 Surcharge
049
Retail Marijuana Sales
18001
Vehicle Daily Rental Fee
077
Retailer’s Use
044
Gaming/ Racing:
Sales
042
Dog Racing*
1421
Sales Tax License Renewal*
242
Gaming
141
Special District Sales
04202
Gaming Backup Withholding*
01114
Special Event Sales
04201
Horse Racing*
1422
Special Event Sales License
04212
Severance:
Racing Cash Fund*
1423
Racing Source Market Fee
140
Coal
08503
Income:
Coal Estimated*
08502
Corporation
01312
Metallic Minerals
08603
Corporation Estimated*
01212
Metallic Minerals Estimated*
08602
Corporation Extension*
01412
Molybdenum
08613
Estate/ Trust Estimated Income
01704
Oil, Gas, & CO2
08403
Fiduciary
017
Oil, Gas, & CO2 Estimated*
08402
Individual Income
01304
Oil Shale
08103
Oil Shale Estimated*
08102
Severance Withholding*
01180
Severance Withholding Annual Reconciliation
01181
*Do not file a tax return for these tax payments, the EFT transaction is the filing. For all other tax payments,
a tax return is required.

Download Form DR 5785 Electronic Funds Transfer (Eft) Account Setup for Tax Payments - Colorado

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