Arizona Form  
                                          Employer’s Withholding Tax Signature Authorization
            AZ-8879-W                                                                                                                       2022

    Do not mail this form to the Arizona Department of Revenue.  The Employer must retain this document a minimum of four years.
Employer’s Name                                                                                                   Employer Identification Number (EIN)

Employer’s Physical Address

City, Town                                                                              State                     ZIP Code

Purpose of form
• To declare, under penalties of perjury, that the electronic withholding tax return is, to the best of the employer’s knowledge and belief, true, correct, and 
 complete.
• To authorize the transmitter to transmit the employer’s confidential information to the Arizona Department of Revenue and transmit acknowledgement, 
 acceptance or rejection messages regarding the employer’s return to the employer.

PART 1 – WITHHOLDING TAX RETURN INFORMATION                                            PART 2 – FINANCIAL INSTITUTION INFORMATION
                                                                                       Must be present when requesting direct debit.
    1Total liability .................................................... 1            TYPE OF ACCOUNT            ROUTING NUMBER
    2Prior payments ...............................................       2             Checking     Savings
    3Amount due or refund ....................................            3            ACCOUNT NUMBER
If line 3 is zero, leave box 4, box 5, line 4 and line 5 blank; otherwise 
check box 4 or box 5:                                                                  DIRECT DEBIT REQUEST DATE  DIRECT DEBIT PAYMENT AMOUNT
 4    AMOUNT DUE:  Enter the amount due ...                              4            M M  D D Y Y Y Y           $                          .00
   5  REFUND:  Enter the amount of refund ....                           5             Foreign Account:  See instructions below.

 Box 4 – Amount Due:  You owe tax based on the information provided                    Foreign Account Checkbox:  Check the “Foreign Account” box if the 
 on  your  withholding  tax  return.    If  you  have  elected  to  direct  debit  for employer’s debit will ultimately come from a foreign account.  If you 
 payment, the payment will be withdrawn from the account on the date                   check this box, do not enter the employer’s bank account information, 
 listed in Part 2: Financial Institution Information.                                  we will not direct debit the account.  If the employer owes tax and is 
 Box 5 – Refund:  You are due a refund based on the information provided               required to pay by EFT, submit payment by ACH Credit to avoid 
 on your withholding tax return.  After the return is processed and payments           penalty.  If the employer owes tax and is NOT required to pay by 
 are  confirmed,  the  overpayment  will  be  applied  to  any  outstanding            EFT,  submit  payment by  ACH Credit or  complete Form  A1-WP, 
 liabilities, possibly in another tax type. If the overpayment exceeds the             mail it and a check to the Arizona Department of Revenue, PO Box 
 outstanding  liabilities  or the employer  has no outstanding  liabilities,  a        29085, Phoenix, AZ  85038-9085.
 refund check will be issued and mailed to the employer. A refund will not 
 be issued once the overpayment is applied to a liability.
PART 3 – DECLARATION AND SIGNATURE AUTHORIZATION (Sign only after completing Part I)
Under penalties of perjury, I declare that I have examined a paper copy of my electronic Arizona withholding tax return and accompanying schedules and 
statements for the period ending M M  D D Y Y Y Y , and to the best of my knowledge and belief, it is true, correct, and complete. I further declare 
that the amounts of Total Liability (Part 1, line 1), Prior Payments (Part 1, line 2), and Amount Due or Refund (Part 1, line 3 and line 4 or line 5) listed above 
are the amounts shown on the paper copy of my electronic Arizona withholding tax return.
I authorize the Arizona Department of Revenue (DOR) and its designated financial agent to initiate an ACH electronic funds withdrawal (direct debit) entry 
to the financial institution account indicated in the tax preparation software for payment of my Arizona withholding taxes owed on this return. I also authorize 
the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and 
resolve issues related to the payment.
If I have filed a return with an amount due, I understand that if the DOR does not receive full and timely payment of my tax liability by the due date, I will 
remain liable for the tax liability and all applicable interest and penalties.
I consent to sending my electronic Arizona withholding tax return and accompanying schedules and statements to DOR through a transmitter. I consent to 
DOR sending my transmitter an acknowledgement of receipt of transmission and an indication of whether or not the transmission of my return is accepted 
and, if the return is rejected, the reason(s) for the rejection. If the processing of my return or refund is delayed, I authorize DOR to disclose to my transmitter 
the reason(s) for the delay, or when the refund was mailed. If DOR contacts my transmitter for a copy of my return, any attachments or schedules to my 
return, and/or this authorization form, I authorize my transmitter to release copies of the requested documents to DOR.

     Please 
     Sign 
     Here                                                                                                                     (            )
                     EMPLOYER’S SIGNATURE                                                              DATE                   BUSINESS PHONE NUMBER
ADOR 11155 (21)