CDTFA-555-LJ (FRONT) REV.   ( -5 4 20)                                                                            STATE OF CALIFORNIA
EFT AUTHORIZATION AGREEMENT FOR LOCAL JURISDICTIONS                                                       CALIFORNIA DEPARTMENT OF 
                                                                                                          TAX AND FEE ADMINISTRATION

➢ Please type or print clearly in ink.
➢ See reverse for complete instructions.

  SELECT ACTION REQUESTED                                     SELECT TAX PROGRAM
  New EFT Account                                            1 percent Local Tax
  Change EFT Bank Account – (see instructions)               ¼ percent (County) Transportation Fund
  Cancel EFT                                                 Add-on (Special District) Tax
                                                             Local Utility User Tax/Local 911 Charges

SECTION I
NAME OF LOCAL JURISDICTION OR SPECIAL DISTRICT (payee)                                       JURISDICTION CODE

CONTACT PERSON (name and title)                                                              EMAIL ADDRESS

MAILING ADDRESS                                                           CITY, STATE, ZIP CODE

CONTACT TELEPHONE NUMBER                                                  CONTACT FAX NUMBER

SECTION II
The State Controller’s Office, on behalf of the California Department of Tax and Fee Administration (CDTFA), is hereby 
authorized to make direct deposit (EFT) of any amounts distributed pursuant to the Bradley-Burns Uniform Local Sales and 
Use Tax Law, the Transactions and Use Tax Law, or the Local Prepaid Mobile Telephony Services Collection Act less any 
mandatory withholding or deductions therefrom to the designated bank account identified below. If the designated EFT 
account is a checking account, a voided check or copy must be attached to the completed authorization agreement. 
If the account is a savings or other deposit-only account, an account confirmation from the bank must be attached.                    
The voided check or confirmation will be used to verify the bank account and transit routing numbers.
BANK NAME

BANK ACCOUNT NUMBER (not to exceed 17 digits)

TRANSIT ROUTING NUMBER

TYPE OF ACCOUNT 
 CHECKING                       SAVINGS

                                                             IMPORTANT
Payee agrees that in the event that the payee owes a debt determined either by court order, or otherwise by operation of 
law, and for which the CDTFA has been notified according to law, to make repayments by deductions from Local Sales and 
Use Tax transmittals, the payee will be removed from the EFT program until the debt is extinguished.
I affirm that deposits received from CDTFA will not be forwarded in their entirety to a foreign financial institution.
SIGNATURE                                              TITLE                                                  DATE

                                                       Return this form to:
                                               California Department of Tax and Fee Administration 
                                                       Local Revenue Branch 
                                                             Warrant Desk 
                                                       PO Box 942879, MIC:27 
                                                       Sacramento, CA 94279-0027
                                                       Email to: JServices@cdtfa.ca.gov
                                                       For EFT assistance call 1-916-309-5802
                                             This information is confidential and not for public release.

                                                       CLEAR PRINT

CDTFA-555-LJ (BACK) REV.   ( -5 4 20)

                                     INSTRUCTIONS FOR LOCAL JURISDICTIONS FOR
                                     COMPLETING THE EFT AUTHORIZATION AGREEMENT FORM
GENERAL
➢ Read this agreement carefully, and if you have questions call 1-916-309-5802.
➢ Please type or print clearly.
➢ Check one action box and one tax program box. Your jurisdiction’s tax program can be found on the title line of the
  remittance advice received from the State Controller’s Office.
➢ Complete all information blocks.

SECTION I
➢ Your jurisdiction code can be found on the remittance advice immediately above the word “Payee.”
➢ Please enter the jurisdiction code for the corresponding jurisdiction type:
  City or County (1 percent Local Tax) Code (five digits)
  County (1/4 percent Tax) Code (two digits)
  Redevelopment Agency Code (four digits)
  District Add-on Code (three digits)
  Local Utility User Tax/Local 911 (Prepaid Mobile Telephony Services) Code (four digits)
➢ A contact person and telephone number are required to process your authorization agreement.

SECTION II
➢ The “Transit Routing Number” (nine digits) typically can be found in the bottom left-hand corner of your check.
➢ Please indicate the type of account (checking or savings).
➢ Be sure to include a voided check or bank confirmation with your authorization agreement.

ADDITIONAL INFORMATION
➢ Changing EFT Bank Account
  • IMPORTANT: DO NOT CLOSE YOUR OLD ACCOUNT UNTIL THE FIRST EFT PAYMENT IS DEPOSITED 
    INTO THE NEWLY DESIGNATED ACCOUNT.
  • This agreement will remain in effect until the CDTFA is notified in writing that you wish to redesignate your 
    account and/or your financial institution or that you wish to cancel EFT service.
  • To redesignate, please submit a new EFT Authorization Agreement for Local Jurisdictions. Be sure to check the 
    correct action box on the front of the form and provide the correct new information.
  • The first deposit into a new account should be made within 60 days from the CDTFA’s receipt of the completed 
    EFT Authorization Agreement.
  • In the interim between the closing of the old account and opening of the new account, you may receive a 
    warrant via U.S. Mail.

➢ Canceling EFT Service
  • To cancel EFT service, submit a new EFT Authorization Agreement for Local Jurisdictions, and check the
    “CANCEL EFT” box. Be sure to complete all information blocks.

➢ EFT Direct Deposit Posting Dates
  • Funds will be deposited on the “Warrant Issue Date” as shown on the CDTFA’s Allocation Calendar. Calendars 
    can be found in publication 28, Tax Information for City and County Officials, downloaded from the CDTFA’s 
    website at www.cdtfa.ca.gov/formspubs/pub28.pdf (see exhibits), or requested from the Local Revenue Branch 
    at 1-916-309-5800.
  • Most financial institutions post funds to accounts at the beginning of the bank business day; however, you 
    should confirm your particular bank’s practice to determine when funds will be available.