Form EFT-100C "ACH Credit Payment Method Authorization Agreement" - North Carolina

What Is Form EFT-100C?

This is a legal form that was released by the North Carolina Department of Revenue - a government authority operating within North Carolina. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2018;
  • The latest edition provided by the North Carolina Department of Revenue;
  • 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 EFT-100C by clicking the link below or browse more documents and templates provided by the North Carolina Department of Revenue.

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Download Form EFT-100C "ACH Credit Payment Method Authorization Agreement" - North Carolina

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EFT-100C
PRINT
CLEAR
Web-Fill
ACH Credit Payment Method Authorization Agreement
6-18
Business Name
(First 30 Characters) (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
Federal Employer ID Number
Address
Office Use Only
City
State
Zip Code (First 5 digits)
Name of Contact Person
Contact Phone Number
Social Security Number
Title of Contact Person
Contact Fax Number
Contact Business Name (If different than above)
Fill in applicable circle:
Initial registration - mandatory participant
Address (If different than above)
Initial registration - voluntary participant
Change of Information
State
Zip Code (First 5 digits)
City
(Effective Date:
)
Part 1. Tax Type
Fill in applicable circle to select tax type:
Enter your Streamlined Sales Account ID
Streamlined Sales and Use
0 0 S
Enter your Motor Fuels Account ID/ NCDOR ID
Motor Fuels
Alcoholic Beverage
Sales and Use
Enter your Account ID/ NCDOR ID for the tax type selected
Severance
0 0
Tobacco Products
Combined General Rate Sales and Use (Utility, Liquor, Gas, and Other)
Withholding
Fill in applicable circle for tax type (Federal Employer ID is required):
Corporate Estimated
Insurance Premium
Part 2. Authorized Signature
I certify that the individual named above as the contact person is authorized to act on behalf of the taxpayer in regards to ACH Credit transactions for the tax type indicated.
Authorized Signature
Title
Date
MAIL TO: Electronic Payments Unit,
North Carolina Department of Revenue, P.O. Box 25000, Raleigh, North Carolina 27640-0001
or FAX TO: 919-733-3149
4
EFT-100C
PRINT
CLEAR
Web-Fill
ACH Credit Payment Method Authorization Agreement
6-18
Business Name
(First 30 Characters) (USE CAPITAL LETTERS FOR YOUR NAME AND ADDRESS)
Federal Employer ID Number
Address
Office Use Only
City
State
Zip Code (First 5 digits)
Name of Contact Person
Contact Phone Number
Social Security Number
Title of Contact Person
Contact Fax Number
Contact Business Name (If different than above)
Fill in applicable circle:
Initial registration - mandatory participant
Address (If different than above)
Initial registration - voluntary participant
Change of Information
State
Zip Code (First 5 digits)
City
(Effective Date:
)
Part 1. Tax Type
Fill in applicable circle to select tax type:
Enter your Streamlined Sales Account ID
Streamlined Sales and Use
0 0 S
Enter your Motor Fuels Account ID/ NCDOR ID
Motor Fuels
Alcoholic Beverage
Sales and Use
Enter your Account ID/ NCDOR ID for the tax type selected
Severance
0 0
Tobacco Products
Combined General Rate Sales and Use (Utility, Liquor, Gas, and Other)
Withholding
Fill in applicable circle for tax type (Federal Employer ID is required):
Corporate Estimated
Insurance Premium
Part 2. Authorized Signature
I certify that the individual named above as the contact person is authorized to act on behalf of the taxpayer in regards to ACH Credit transactions for the tax type indicated.
Authorized Signature
Title
Date
MAIL TO: Electronic Payments Unit,
North Carolina Department of Revenue, P.O. Box 25000, Raleigh, North Carolina 27640-0001
or FAX TO: 919-733-3149
Page 2
ACH Credit Payment Method Authorization Agreement
EFT-100C
Instructions
Web-Fill
6-18
Taxpayer Information
Business Name and Address
Enter the business name and address of the taxpayer.
Name and Address of Contact Person
This is the individual the Department will contact should there be any question about an EFT tax payment and to whom
all correspondence about the EFT Program will be directed. If this person is not employed by the taxpayer, then the
Contact Business Name and Address must be noted (i.e.: XYZ Payroll Service).
Federal Employer ID Number/SSN number
If the business is a corporation, provide the Federal Employer ID Number. If the business is a sole proprietorship, provide
the owner’s Social Security Number.
Mandatory or Voluntary Participant
As a mandatory participant, you must pay electronically until further notified.
Change of Information
If any information has changed since previously registering, such as the business name, contact person, or Account ID,
please complete a new authorization agreement with the updated information. Indicate the date the changes should
take effect. Normally, changes require 2-3 business days to be processed before becoming effective.
Tax Type
Fill in the circle for the appropriate tax type. You must complete a separate ACH Credit Payment Method Authorization
Agreement for each tax type.
Account ID Number
The department has replaced some Tax Account ID numbers with a NCDOR ID number. If you have received a NCDOR
ID please begin using it if applicable.
If your tax type requires an Account ID/NCDOR ID, please enter in the boxes next to the appropriate tax type selection.
Streamlined Sales and Use should register and pay using the Streamlined Sales and Use section by entering the
Streamline Sales account ID.
General Instructions
ACH Credit Payment Method
To make payments by ACH Credit, first contact your financial institution to confirm they offer ACH Credit origination
services. After registering with the Department for the ACH Credit method (by submitting a completed ACH Credit Payment
Method Authorization Agreement), please review the ACH Credit Instructions and Guidelines on our website www.ncdor.
gov/documents/ach-credit-instructions-and-guidelines.
Authorized Signature
An individual authorized to act on behalf of the taxpayer in regards to ACH Credit payment transactions must sign this
Authorization Agreement. Generally, this is the person with the authority to sign a tax return.
Other Payment Methods
For your convenience, other electronic payment methods are available through our website at www.ncdor.gov. Bank
Draft (ACH Debit), Debit or Credit Card (Visa or MasterCard) may also be used to satisfy mandatory electronic payment
requirements.
Taxpayers that wish to remit Streamlined Sales Tax by the ACH Debit payment method, may do so using the SSTP XML
Payment Schema when submitting the Streamlined Simplified Electronic Return (SER) or separately. Both require the
use of web services to submit XML Schema. Additional information about the Streamlined XML Schemas can be found
on the website for the Streamlined Sales Tax Governing Board, Inc. at http://www.streamlinedsalestax.org by clicking
on the Technology link.
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