Form EFT-1 "Authorization Agreement for Certain Electronic Payments" - Illinois

What Is Form EFT-1?

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

Form Details:

  • Released on June 1, 2016;
  • The latest edition provided by the Illinois 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-1 by clicking the link below or browse more documents and templates provided by the Illinois Department of Revenue.

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Download Form EFT-1 "Authorization Agreement for Certain Electronic Payments" - Illinois

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Illinois Department of Revenue
EFT‑1
Authorization Agreement for Certain Electronic Payments
Read this information first:
Complete this form ONLY if you 1) want to pay amounts owed to the Illinois Department of Revenue
using ACH credit; pay-by-phone debit; direct file debit for telecommunications, tobacco, and liquor; or cigarette tax stamp purchase debit; or 2)
are changing previously submitted information about one of the methods of payment listed above. Note: For most taxes, electronic payments
can be made easily on our website at tax.illinois.gov using MyTax Illinois (do not complete Form EFT-1 if you pay using MyTax Illinois).
Step 1: Complete the following information
1
2
Check the payment method you wish to use (or wish to update).
Check the reason you are completing this form.
a
ACH credit
Initial set up (Check this box and skip to Step 2.)
b
Pay-by-phone debit
Change to previously submitted information
3
If a change, write the effective date. ____/____/________
Direct file debit for telecommunications, tobacco
,
c
and liquor
4
Explain the change:___________________________
d
Cigarette tax stamp purchase debit
(required method for RC-1-A)
Step 2: Identify yourself
5
7 ___ ___ ‑ ___ ___ ___ ___ ___ ___ ___
_________________________________________________
Taxpayer’s name
Federal employer identification number (FEIN)
6
8 ___ ___ ___ ‑ ___ ___ ‑ ___ ___ ___ ___
_________________________________________________
Address
Social Security number (SSN)
_________________________________________________
City
State
ZIP
Step 3: Complete designated agent or contact person information
9
11
_________________________________________________
(_____)_________________ (_____)__________________
Designated agent’s or contact person’s name
Telephone
Fax
10
12
_________________________________________________
_________________________________________________
Address
Email address
13
_________________________________________________
_________________________________________________
City
State
ZIP
Signature authorization (authorized officer of designated agent or contact person)
Step 4: Check the taxes for which you wish to authorize these payments
Illinois income taxes:
Excise taxes continued:
Individual Income Tax
_____________________
Electricity Excise Tax
_____________________
Illinois Account ID number
Illinois Account ID number
Withholding Income Tax
_____________________
Gas Revenue/Gas Use Tax
_____________________
Illinois Account ID number
Illinois Account ID number
Hotel Operators’ Occupation Tax
_____________________
Business Income Tax
_____________________
Illinois Account ID number
Illinois Account ID number
Sales taxes:
Liquor Tax - Airline
_____________________
Illinois Account ID number
Sales/Use Tax & E911 Surcharge
_____________________
Liquor Tax - Importer/MFTR/Dist
_____________________
Illinois Account ID number
Illinois Account ID number
Chicago Soft Drink Tax
_____________________
Liquor Tax - Direct Wine Shipper
_____________________
Illinois Account ID number
Illinois Account ID number
County Motor Fuel Tax
_____________________
Motor Fuel Tax-Dist./Supplier
_____________________
Illinois Account ID number
(ACH credit only)
Illinois Account ID number
MPEA Food and Beverage Tax
_____________________
Motor Fuel Tax-UST/EIF Receiver _____________________
Illinois Account ID number
(ACH credit only)
Illinois Account ID number
Prepaid Sales Tax (motor fuel)
_____________________
Motor Fuel Tax-Alternative Fuels
_____________________
Illinois Account ID number
(ACH credit only)
Illinois Account ID number
Automobile Renting Tax
_____________________
Telecommunications Excise Tax
_____________________
Illinois Account ID number
Illinois Account ID number
Excise taxes:
Telecom Infrastruct. Maint. Fee
_____________________
Cigarette Tax Stamp Purchase
_____________________
Illinois Account ID number
(Debit only)
Illinois Account ID number
Tobacco Products Tax
_____________________
Electricity Distribution and
Illinois Account ID number
Invested Capital Tax
_____________________
Illinois Account ID number
EFT-1 front (R-06/16)
Illinois Department of Revenue
EFT‑1
Authorization Agreement for Certain Electronic Payments
Read this information first:
Complete this form ONLY if you 1) want to pay amounts owed to the Illinois Department of Revenue
using ACH credit; pay-by-phone debit; direct file debit for telecommunications, tobacco, and liquor; or cigarette tax stamp purchase debit; or 2)
are changing previously submitted information about one of the methods of payment listed above. Note: For most taxes, electronic payments
can be made easily on our website at tax.illinois.gov using MyTax Illinois (do not complete Form EFT-1 if you pay using MyTax Illinois).
Step 1: Complete the following information
1
2
Check the payment method you wish to use (or wish to update).
Check the reason you are completing this form.
a
ACH credit
Initial set up (Check this box and skip to Step 2.)
b
Pay-by-phone debit
Change to previously submitted information
3
If a change, write the effective date. ____/____/________
Direct file debit for telecommunications, tobacco
,
c
and liquor
4
Explain the change:___________________________
d
Cigarette tax stamp purchase debit
(required method for RC-1-A)
Step 2: Identify yourself
5
7 ___ ___ ‑ ___ ___ ___ ___ ___ ___ ___
_________________________________________________
Taxpayer’s name
Federal employer identification number (FEIN)
6
8 ___ ___ ___ ‑ ___ ___ ‑ ___ ___ ___ ___
_________________________________________________
Address
Social Security number (SSN)
_________________________________________________
City
State
ZIP
Step 3: Complete designated agent or contact person information
9
11
_________________________________________________
(_____)_________________ (_____)__________________
Designated agent’s or contact person’s name
Telephone
Fax
10
12
_________________________________________________
_________________________________________________
Address
Email address
13
_________________________________________________
_________________________________________________
City
State
ZIP
Signature authorization (authorized officer of designated agent or contact person)
Step 4: Check the taxes for which you wish to authorize these payments
Illinois income taxes:
Excise taxes continued:
Individual Income Tax
_____________________
Electricity Excise Tax
_____________________
Illinois Account ID number
Illinois Account ID number
Withholding Income Tax
_____________________
Gas Revenue/Gas Use Tax
_____________________
Illinois Account ID number
Illinois Account ID number
Hotel Operators’ Occupation Tax
_____________________
Business Income Tax
_____________________
Illinois Account ID number
Illinois Account ID number
Sales taxes:
Liquor Tax - Airline
_____________________
Illinois Account ID number
Sales/Use Tax & E911 Surcharge
_____________________
Liquor Tax - Importer/MFTR/Dist
_____________________
Illinois Account ID number
Illinois Account ID number
Chicago Soft Drink Tax
_____________________
Liquor Tax - Direct Wine Shipper
_____________________
Illinois Account ID number
Illinois Account ID number
County Motor Fuel Tax
_____________________
Motor Fuel Tax-Dist./Supplier
_____________________
Illinois Account ID number
(ACH credit only)
Illinois Account ID number
MPEA Food and Beverage Tax
_____________________
Motor Fuel Tax-UST/EIF Receiver _____________________
Illinois Account ID number
(ACH credit only)
Illinois Account ID number
Prepaid Sales Tax (motor fuel)
_____________________
Motor Fuel Tax-Alternative Fuels
_____________________
Illinois Account ID number
(ACH credit only)
Illinois Account ID number
Automobile Renting Tax
_____________________
Telecommunications Excise Tax
_____________________
Illinois Account ID number
Illinois Account ID number
Excise taxes:
Telecom Infrastruct. Maint. Fee
_____________________
Cigarette Tax Stamp Purchase
_____________________
Illinois Account ID number
(Debit only)
Illinois Account ID number
Tobacco Products Tax
_____________________
Electricity Distribution and
Illinois Account ID number
Invested Capital Tax
_____________________
Illinois Account ID number
EFT-1 front (R-06/16)
Taxpayer’s name
_________________________________________________
Step 5: Complete the following if you checked Step 1, Line 1, Box b, c, or d
14
17
_________________________________________________
Check one:
Business
Individual/Consumer
or
Financial institution’s name
15
18
_________________________________________________
Check one:
Checking
Savings
or
Name on account
16
19 ___ ___ ___ ___ ___ ___ ___ ___ ___
_________________________________________________
Account number
Routing transit number
Step 6: Sign and complete
The signature of the taxpayer, authorized officer, or partner is required, as well as the title and date (even if you are using a designated agent).
For a debit payment method, I agree and understand that I am authorizing the Illinois Department of Revenue (IDOR) to make withdrawals
from the financial institution account listed in Step 5 when payments are scheduled.
Under penalties of perjury, I state that I have examined this form and to the best of my knowledge it is true, correct, and complete. The Illinois
Department of Revenue is authorized to use this information in accordance with the Department of Revenue Law of the Civil Administrative
Code of Illinois and all applicable Illinois tax acts. This agreement shall remain in force until the Department receives written notification from
the taxpayer.
_________________________________________________
_______________________
____/____/________
Signature of taxpayer, authorized officer, or partner
Title
Date
Step 7: Mail or fax completed form
Mail to:
ELECTRONIC FUNDS TRANSFER DIVISION
Fax number: 217 524‑8282
ILLINOIS DEPARTMENT OF REVENUE
PO BOX 19015
Reset
Print
SPRINGFIELD IL 62794‑9015
Form EFT‑1 Instructions
General Information
option for Illinois Individual Income Tax (follow the instructions
at tax.illinois.gov and please note a convenience fee will be
What payment methods require that I complete
assessed for each credit card transaction).
Form EFT‑1?
What if I need help?
Form EFT‑1 is required prior to making the following electronic
If you need assistance, you may call us weekdays between 8 a.m.
payments:
and 5 p.m. at 217 782‑6257. You also may visit our website at
• Automated Clearing House (ACH) credit - This is an electronic
tax.illinois.gov or write to us
at:
transfer that occurs when you authorize your financial institution to
ELECTRONIC FUNDS TRANSFER DIVISION
credit the Department’s account. We will send you instructions for
ILLINOIS DEPARTMENT OF REVENUE
the CCD+TXP Tax Payment Addenda Format that your financial
PO BOX 19015
institution should use for each credit payment. We recommend that
SPRINGFIELD IL 62794‑9015
you contact your bank to determine what ACH services it offers
before you choose this option. (This is the only electronic payment
Specific Instructions
option on Form EFT-1 for motor fuel accounts.)
• Debit - This is an electronic transfer that occurs when you authorize
Step 1: Complete the following information
our agent to transfer funds from your account.
Check the payment method you wish to use and whether this is an
• Pay-by-phone debit method: This option is available for most
initial registration or if you are changing information you previously
tax accounts. You must complete a separate Form EFT-1 for
provided. Attach additional sheets if necessary.
each account from which you will make payments.
Step 3: Complete designated agent or contact
• Direct file debit method for telecommunications, tobacco, and
person information
liquor taxpayers: If you will be filing and paying using software
If a designated agent will be transferring payments, complete Step 3.
you develop or purchase, you are required to complete Form
If the designated agent is completing Form EFT-1 on behalf of a
EFT-1 for the account from which you will make payments.
taxpayer, the taxpayer must provide a signature in Step 6, unless a
• Cigarette tax stamp purchasers: You are required to use the
signed Form IL-2848-E is kept in the designated agent’s records.
debit payment method for your cigarette tax stamp orders. You
must complete Form EFT-1 for the account from which you will
If the pay-by-phone option will be used and if the bank account
make payments.
is the designated agent’s, an authorized officer of the agent
IMPORTANT: Do not complete Form EFT‑1 to make the
must sign on Step 3, Line 13, to authorize us to debit that account.
following electronic payments: 1) debit using MyTax Illinois
The contact person should be the person who will be initiating and
at tax.illinois.gov (you must enter your account information
making the payment transfer. Include the contact’s telephone number,
and follow the instructions); 2) direct file debit for any tax other
fax number, and email address.
than telecommunications, tobacco, or liquor; or 3) credit card
This form is authorized as outlined under the tax or fee Act related to the tax or fee for which this form is filed. Disclosure of this
EFT-1 back (R-06/16)
information is required. Failure to provide information may result in this form not being processed and may result in a penalty.
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