Form CDTFA-555-ST "Authorization Agreement for Electronic Funds Transfer (Eft)" - California

What Is Form CDTFA-555-ST?

This is a legal form that was released by the California Department of Tax and Fee Administration - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2017;
  • The latest edition provided by the California Department of Tax and Fee Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CDTFA-555-ST by clicking the link below or browse more documents and templates provided by the California Department of Tax and Fee Administration.

ADVERTISEMENT
ADVERTISEMENT

Download Form CDTFA-555-ST "Authorization Agreement for Electronic Funds Transfer (Eft)" - California

1239 times
Rate (4.7 / 5) 62 votes
CDTFA-555-ST (FRONT) REV. 9 (8-17)
STATE OF CALIFORNIA
AUTHORIZATION AGREEMENT FOR
CALIFORNIA DEPARTMENT OF
ELECTRONIC FUNDS TRANSFER (EFT)
TAX AND FEE ADMINISTRATION
New EFT account
Change EFT reporting method
Please Check Appropriate Boxes:
Change bank account on
(date)
See reverse for instructions.
Change contact information
(Type or Print in Ink)
TAXPAYER AND CONTACT INFORMATION
TAXPAYER NAME
CDTFA ACCOUNT NUMBER
DBA (doing business as)
BUSINESS PHONE NUMBER
(
)
CONTACT PERSON
CONTACT PHONE NUMBER
(
)
PAYMENT OPTIONS
Complete and sign either OPTION 1 or OPTION 2 below (NOT BOTH)
OPTION 1
ACH Debit
The California Department of Tax and Fee Administration is hereby authorized to initiate debit entries to the bank account identifed below
and the bank is authorized to debit such account. This authority is to remain in full force until EFT payments are no longer required by
statute or, if I am a voluntary participant, until the California Department of Tax and Fee Administration and I mutually agree to terminate
my participation in the EFT program.
BANK NAME
TYPE OF ACCOUNT
BANK ACCOUNT NUMBER (not to exceed 17 digits)
Checking
Savings
ROUTING NUMBER:
SIGNATURE
TITLE
DATE
IMPORTANT: If you have selected the ACH Debit option, you must attach a voided check. Your voided check will be used to verify the bank
account and routing numbers. If you are unable to provide a voided check, a bank specifcation sheet may be used.
OPTION 2 (Do not complete if you have completed OPTION 1 above.)
ACH Credit
The California Department of Tax and Fee Administration is hereby requested to grant authority for the above‑named taxpayer to initiate
ACH credit transactions to the California Department of Tax and Fee Administration’s bank account. These payments must be in the NACHA
CCD+ format using the Tax Payment Convention (TXP) and may only be initiated for the EFT tax payments to the California Department of
Tax and Fee Administration provided for by statute.
SIGNATURE
TITLE
DATE
Return to: California Department of Tax and Fee Administration, Attn. Return Processing Branch,
PO Box 942879, Sacramento, CA 94279-0088
or fax to 1-916-327-0859
For EFT assistance call the Customer Service Center at 1-800-400-7115 (TTY:711)
Make a copy for your records.
CLEAR
PRINT
CDTFA-555-ST (FRONT) REV. 9 (8-17)
STATE OF CALIFORNIA
AUTHORIZATION AGREEMENT FOR
CALIFORNIA DEPARTMENT OF
ELECTRONIC FUNDS TRANSFER (EFT)
TAX AND FEE ADMINISTRATION
New EFT account
Change EFT reporting method
Please Check Appropriate Boxes:
Change bank account on
(date)
See reverse for instructions.
Change contact information
(Type or Print in Ink)
TAXPAYER AND CONTACT INFORMATION
TAXPAYER NAME
CDTFA ACCOUNT NUMBER
DBA (doing business as)
BUSINESS PHONE NUMBER
(
)
CONTACT PERSON
CONTACT PHONE NUMBER
(
)
PAYMENT OPTIONS
Complete and sign either OPTION 1 or OPTION 2 below (NOT BOTH)
OPTION 1
ACH Debit
The California Department of Tax and Fee Administration is hereby authorized to initiate debit entries to the bank account identifed below
and the bank is authorized to debit such account. This authority is to remain in full force until EFT payments are no longer required by
statute or, if I am a voluntary participant, until the California Department of Tax and Fee Administration and I mutually agree to terminate
my participation in the EFT program.
BANK NAME
TYPE OF ACCOUNT
BANK ACCOUNT NUMBER (not to exceed 17 digits)
Checking
Savings
ROUTING NUMBER:
SIGNATURE
TITLE
DATE
IMPORTANT: If you have selected the ACH Debit option, you must attach a voided check. Your voided check will be used to verify the bank
account and routing numbers. If you are unable to provide a voided check, a bank specifcation sheet may be used.
OPTION 2 (Do not complete if you have completed OPTION 1 above.)
ACH Credit
The California Department of Tax and Fee Administration is hereby requested to grant authority for the above‑named taxpayer to initiate
ACH credit transactions to the California Department of Tax and Fee Administration’s bank account. These payments must be in the NACHA
CCD+ format using the Tax Payment Convention (TXP) and may only be initiated for the EFT tax payments to the California Department of
Tax and Fee Administration provided for by statute.
SIGNATURE
TITLE
DATE
Return to: California Department of Tax and Fee Administration, Attn. Return Processing Branch,
PO Box 942879, Sacramento, CA 94279-0088
or fax to 1-916-327-0859
For EFT assistance call the Customer Service Center at 1-800-400-7115 (TTY:711)
Make a copy for your records.
CLEAR
PRINT
CDTFA-555-ST (BACK) REV. 9 (8-17)
Instructions for Completing the EFT Authorization Agreement Form
TAXPAYER AND CONTACT INFORMATION
Please type or print clearly.
Complete all the blocks in the section. Your California Department of Tax and Fee Administration (CDTFA) account number is required (for
example, 044-123456).
Make a copy of the completed form for your records.
Payment OPTIONS
Complete and sign OPTION 1 (ACH Debit) or OPTION 2 (ACH Credit). DO NOT COMPLETE BOTH.
Complete every block of information for the method selected.
If the ACH Debit method is selected, attach a voided check or a bank specification sheet so the CDTFA can verify your bank account
number and routing number.
The example voided check below indicates where to locate the routing number and bank account number. Some financial institutions may
use a different routing number for electronic payments than the one used for paper checks. You may want to verify the information with your
financial institution before submitting it. Do NOT use a deposit slip to obtain the information requested. Failure to enter the correct banking
information may cause your payment to be rejected and may subject your account to delinquency charges.
Remember to mark the word “void” across the face of the check that you send with the authorization agreement.
1
Routing Number
(requires 9 digits)
2
Bank Account Number
(not to exceed 17 digits)
3
Check Number
Important Information
1.
EFT Start Date for New Accounts
You will be notified in writing if your agreement is approved. The confirmation letter will indicate when you must start making EFT payments. DO NOT
attempt to pay by EFT before your approved start date.
2.
Removal from EFT
Once you are registered, you cannot withdraw from the EFT program unless you submit a written request and you receive a written approval from the
CDTFA.
You can fax the request to 1-916-327-0859 or mail it to Return Processing Branch, P.O. Box 942879, Sacramento, CA 94279-0088. You must continue to
make payments by EFT until the CDTFA notifies you in writing that your request has been approved and indicates the ending date for making EFT payments.
Note: If your account is closing out, a written request for removal from EFT is not required.
3.
Changing Your Payment Method (ACH Debit vs. ACH Credit)
If you are submitting an authorization agreement form to change from ACH Debit to ACH Credit, or vice versa, you must continue to use your current
payment method until you are notified in writing by the CDTFA that your request has been approved. A confirmation letter will be mailed to you once your
method of payment has been changed.
4.
New Bank Account or Routing Number
If you are submitting an authorization agreement form to change your bank account or routing number, you will not receive a confirmation letter.
Page of 2