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EFT1-C 

. 

0191

AUTHORIZATION AGREEMENT FOR 

   ELECTRONIC FUNDS TRANSFER (EFT) Federal Identification Number (9 digits):             Date:

, EFT Unit, Trenton NJ 08646-                         CONTACT TELEPHONE NUMBER  
      
191       
   
and

 ADDRESS ,

NJ Registration Number (12 digits):             Title:

  TYPE                                       CONTACT NAME
 
 / TAX / FEE

PAYMENT

The New Jersey Division of Revenue is hereby requested to grant authority for the above-named taxpayer to initiate ACH Credit transactions to the State of New Jersey, Division of Revenue’s bank account.  These payments must be in  the NACHA CCD+ format using the  Tax Payment Convention (TXP) and  may be initiated for the EFT payments to the New Jersey Division of Revenue provided by statute. The authority is to remain in full force until EFT payments are no longer required by statute or, if I am a voluntary participant, until the New Jersey Division of Revenue and I mutually agree to terminate my participation in the EFT program.  
STATE OF NEW JERSEY DIVISION OF REVENUE ACH CREDIT ENROLLMENT  Reminder: Once qualified for electronic funds transfer (EFT), remit all payments collected by the Division of Revenue using EFT. Sign and date this enrollment form and return to: New Jersey Division of Revenue, PO Box Please note:  All fields are required. Taxpayer Name:                                                                                                                    EMAIL ADDRESS                     Signature: