CDTFA-400-XML  (FRONT)  REV.  2  (10-17)                                                                                                          STATE OF CALIFORNIA  
APPLICATION FOR DIRECT  TRANSMISSION OF TAX RETURNS                                                                              CALIFORNIA DEPARTMENT  OF  
                                                                                                                             TAX AND FEE ADMINISTRATION  
 
    New           Revised             Reinstatement 
 
PLEASE PRINT OR TYPE  –  INSTRUCTIONS ARE AVAILABLE ON THE BACK OF THIS FORM  

1. LEGAL NAME OF DIRECT TRANSMITTER                                                                                FOR CDTFA USE ONLY – CLIENT ID NUMBER 
      
2. BUSINESS NAME(if different from above) 
      
3. BUSINESS ADDRESS (street, city, state, zip code)  
      
4. MAILING ADDRESS (if different than above; street or P.O. Box, city, state,  zip code)  
      
5. BUSINESS CONTACT INFORMATION (phone, fax, and email address)  
      
6. CONTACT REPRESENTATIVE  
Name:                                                                                                    Title:       
Email address:                                                                                           Telephone: (      )       
7. TYPE OF CERTIFICATION  

                                   I WANT TO BE CERTIFIED TO TRANSMIT RETURNS AS  A: (check all that apply) 

     Tax Professional                                                                     Business Name:                 
                                                                                          Name of Software 
     Software Developer                                                                   Product:                       
                                                                                          CDTFA  Account Num-
     Taxpayer or Feepayer                                                                 ber:                           
                                                                                          Web Address                    
     Electronic Return Originator 
                                                                                          Test  Web  Address  (if  
                                                                                          available)                     
 
8. APPLICATION AGREEMENT  
 
Under  penalty  of  perjury,  I  declare that  I  have examined this  application and to the best  of  my  knowledge the information I  have 
provided is true,  correct, and complete.  I  further declare that I am authorized to complete and sign this  statement  on behalf of the 
business.  This  business  and  its  employees  will  comply  with all t he provisions  of  the California  Department  of  Tax  and Fee 
Administration’s Direct Transmitters Guide and related publications. I  understand that if this business is  sold or its  organizational 
structure is changed, acceptance for participation is not transferable and a new/revised application must be filed. I further understand 
that noncompliance with all applicable provisions will result in termination of this  agreement. 

9.NAME AND TITLE OF  THE REPRESENTATIVE COMPLETING THIS FORM  (type or print)  
      
 10.SIGNATURE OF THE REPRESENTATIVE COMPLETING THIS FORM                                             DATE  
                                                                                                           
Please submit  the completed application  via email to eDirect@cdtfa.ca.gov,  or mail t o:  

                                                     California Department of Tax and Fee Administration 
                                                                 eServices Coordinator, MIC:40  
                                                                                          PO Box 942879  
                                                                 Sacramento, CA  94279-0040  

CDTFA-400-XML (BACK)  REV.  2  (10-17)                                                                      STATE OF CALIFORNIA 
APPLICATION FOR DIRECT  TRANSMISSION OF TAX RETURNS                                                         CALIFORNIA DEPARTMENT  OF  
                                                                                                            TAX AND FEE ADMINISTRATION  

                              INSTRUCTIONS FOR COMPLETING THE  APPLICATION  

To become a Direct Transmitter  you must submit your application and  successfully complete testing prior to Direct Transmitting your  
first return or  prepayment.  

You may submit your email to  eDirect@cdtfa.ca.gov,  or  mail  to:  

                                        California Department of Tax and Fee Administration  
                                                    eServices Coordinator,  MIC:40  
                                                       PO  Box 942879  
                                                    Sacramento, CA 94279-0040  

If you have any questions regarding this form or the Direct  Transmit Program, please call 1-916-323-6353, weekdays from 8:00  a.m.  
through  5:00  p.m. (Pacific time),  or by email at eDirect@cdtfa.ca.gov. 

                                                     SPECIAL  INSTRUCTIONS  

Line 1  - Legal Name of Direct Transmitter:  Enter the legal  name of the business.  

Line 2  -  Business Name:  Enter fictitious business name (dba) if  applicable.  

Line 3  -  Business Address:  Enter the address  of the physical location of your business.  
Line 4  -  Mailing Address:  Enter the mailing address  if different than the business address.  

Line 5  -  Business Contact Information:  Enter the business  phone number, fax,  and email address.  

Line 6   - Contact Information: Enter the name, title, phone number,  and email address of  the contact representative.  

Line 7  -  Type of Certification:  If you  are a tax professional (i.e. Accountant, CPA, Bookkeeper,  etc.)  and are not  employed  by  the 
taxpayer  or  feepayer,  select  the Tax  Professional  box  and provide your  name  or  the  name of  your  business.  If  you are a software  
company developing software that  clients  will use to submit  returns  directly  to the CDTFA,  select  the Software Developer  box  and  
provide the name of  the software product. If  you are the  taxpayer  or  feepayer  filing your  own returns,  select  the Taxpayer  or 
Feepayer box  and provide your  account  number.  If  you are a company  offering a web interface for  clients  to submit  tax  and fee  
information (no software provided), select the Electronic Return Originator box and provide your  web address and a test  web address  
(for testing purposes).  

Line 8  -  Application Agreement:  Please read this  section carefully prior to signing this  application.  

Lines  9  and  10  - Name, Title,  Signature  of  the Representative C  ompleting  This F  orm,  and  Date:  The individual  authorized to  
complete and submit an application for the Direct  Transmit Program  must  complete these lines.