DR-600
                                               Enrollment and Authorization for e-Services                                                                   R. 01/15
                                                                                                                                                               TC
                             This form can be completed online                 To enroll for multiple taxes or fees, you must                                Rule 12-24.011
                                                                                                                                            Florida Administrative Code
                             at www.floridarevenue.com                         use a separate form for each tax or fee or                                    Effective 01/15
                                                                               you can enroll online all at once.

                                                    Section 1 – Check the Box That Applies
       Initial enrollment             Change in filing/ payment method          Bank change                                       Contact information change
       Complete all sections          Complete sections 2, 4, 5, and 6          Complete sections 2, 5, and 6                     Complete sections 2, 3, & 6

If you wish to enroll for multiple taxes or accounts, you must use aseparate form for each one  orenroll online using our Internet site.  The online 
application allows you to enroll for all taxes at one time.

                                                      Section 2 – Business Information
Business entity name                                                           Type of tax (Note:Only 1 tax type per form)

FEIN/SSN*                                                                      Tax account/certificate number (if different from FEIN/SSN)

*Social security numbers (SSNs) are used by the Florida Department of Revenue as unique identifiers for the administration of Florida’s taxes.  SSNs obtained for tax 
administration purposes are confidential under sections 213.053 and 119.071, Florida Statutes, and not subject to disclosure as public records.  Collection of your SSN 
is authorized under state and federal law.  Visit our Internet site at www.floridarevenue.com and select “Privacy Notice” for more information regarding the state and 
Federal law governing the collection, use, or release of SSNs, including authorized exceptions.

                                                      Section 3 – Contact Information
                   Electronic Payment Contact Person’s Information                                Electronic Return Contact Person’s Information
Name                                                                           Name

Mailing address                                                                Mailing address

City/State/ZIP                                                                 City/State/ZIP

Telephone number (include area code)           Fax number (include area code)  Telephone number (include area code)            Fax number (include area code)

E-mail address                                                                 E-mail address

Contact is a:       company employee            non-related tax preparer       Contact is a:       company employee             non-related tax preparer
If tax preparer, provide Preparer Taxpayer Identification Number (PTIN):       If tax preparer, provide Preparer Taxpayer Identification Number (PTIN):

If reemployment (RT) agent, provide RT Agent Number                            If reemployment (RT) agent, provide RT Agent Number

                                      Section 4 – Filing/Payment Method Selection and Descriptions
ACH–Debit (e-check) is the action taken when the Department’s bank withdraws a tax payment from the taxpayer’s bank account upon payers 
request; the taxpayer’s account is debited.
ACH–Credit is the action taken when the taxpayer’s bank transfers a tax payment to the Department’s bank account; the Department’s account is 
credited. This is not a credit card payment.

Electronically File              Electronically Pay (select one):    ACH Debit (e-check)                                 ACH Credit    
                                      Section 5 – Banking Information (not required for ACH-Credit)

Bank Name _________________________________________   ABA Routing/Transit No.                                                                                  

Bank Account No.  ___________________________________

Account Type                  Business Checking                           Personal Checking     Business Savings                 Personal Savings

Note:  Due to federal security requirements, we cannot process international ACH transactions.  If any portion of the money used in 
payments you will make will come from financial institutions located outside of the US or its territories for the purpose of funding these 
payments, please contact us to make other payment arrangements. If you are unsure, please contact your financial institution.

             Section 6 – Enrollee Authorization and Agreement
This is an Agreement between the Florida Department of Revenue, hereinafter “the Department,” and the business entity named herein, 
hereinafter “the Enrollee,” entered into according to the provisions of the Florida Statutes and the Florida Administrative Code.
By completing this agreement and submitting this enrollment request, the Enrollee applies and is hereby authorized by the Department to file 
tax returns and reports, make tax and fee payments, and transmit remittances to the Department electronically.  This agreement represents 
the entire understanding of the parties in relation to the electronic filing of returns, reports, and remittances.
The same statute and rule sections that pertain to all paper documents filed or payments made by the Enrollee also govern an electronic 
return, or payment initiated electronically according to this enrollment.
I certify that I am authorized to sign on behalf of the business entity identified herein, and that all information provided in this document 
has been personally reviewed by me and the facts stated in it are true. According to the payment method selected, I hereby authorize the 
Department to present debit entries into the bank account referenced at the depository designated herein (ACH-Debit), or I am authorized to 
register for the ACH-Credit payment privilege and accept all responsibility for the filing of payments through the ACH-Credit method. 

_________________________________________________________________        ______________________________            _____________________________
  Signature                                                              Title                                    Date
_________________________________________________________________        ______________________________
  Print Name                                                             Telephone Number
_________________________________________________________________        ______________________________            _____________________________
  Second signature (if dual signature account)                           Title                                    Date

Most change/update requests can be made online if you are already enrolled and have your user information.

                                               or, Complete and mail this form to:
                                                   Account Management Mail Stop 1-5730
            Enroll online at
                                                   Florida Department of Revenue                                  Call for assistance:
                                                   5050 W Tennessee St
www.floridarevenue.com                                                                                            850-488-6800
                                                   Tallahassee, FL  32399-0160
                                                   Fax 850-488-5997