THE COMMONWEALTH OF MASSACHUSETTS  
              EXECUTIVE OFFICE OF LABOR AND WORKFORCE DEVELOPMENT  
              DEPARTMENT OF UNEMPLOYMENT ASSISTANCE 
   
                 REGISTRATION TO PAY DUA TAXES VIA ACH CREDIT 

 Coany Name:______________________________________________________________________

Company Name: _____________________________________________________________________________ 

*DUA Employer Account Number: _________________________________________________________________ 
 
Federal Identification Number: ____________________________________________________________________ 
 
Street: ______________________________ City: ___________________ State: _________ Zip: _______________ 
 
**Agent/Professional Tax Preparer/Third Party? ID Number: ___________________________________________ 
 
Contact Person: _______________________________________________________________________________ 
 
Email: _______________________________________________________________________________________ 
                 (Please print clearly – you will only receive confirmation via email) 
 
Phone: _______________________________________ Fax: ___________________________________________ 
 
Mail form to: Department of Unemployment Assistance 
              Attention: Employer Reports Unit, Revenue Service, 2 ndFloor 
              19 Staniford Street 
              Boston, MA 02114 
 
              OR 
 
Fax form to: (617) 626-6850 
 
Note: After submittal of this registration, if approved, you will be provided via email with the DUA mandated  
ACH credit record layout and DUA bank account and routing transit numbers. 
 
*Employers must have a DUA Employer Account Number (EAN) to apply. 
 
**Agent/Professional Tax Preparer/Third Party computing their client’s amount owed and/or filing this form on 
behalf of their clients must register with DUA UI Online system as a TPA and receive a TPA ID number. This TPA ID 
number must be included on this form as part of the registration for ACH Credit Processing. To apply for a TPA ID 
number, go to: www.mass.gov/uima, and click on: Third Party Administrator (TPA) UI Online login. 
 
If you want to pay online, please register for UI Online and pay via ACH Debit. 

 5/2018