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                                                                 PRINT           CLEAR

 North Carolina Department 

 of Revenue (NCDOR) 

 Income Tax Letter of Intent  

  Tax Year 2024  
      
 This form must be completed and submitted to AllAboutForms@ncdor.gov  
  by September 9, 2024. 
 If you only support e-File, email the form by November 1, 2024. 
      
 For any general questions about this LOI, please contact AllAboutForms@ncdor.gov. 
                                                                                       

               2024 Tax Software Provider NCDOR Letter of Intent 
 
The North Carolina Department of Revenue (NCDOR) Letter of Intent (LOI) must be completed annually prior to your 
participation in Modernized e-File (MeF) Assurance Testing System (ATS) and/or substitute tax forms approval testing 
with the NCDOR.  Software providers and payroll service providers (Provider or Providers) that want to include North 
Carolina tax forms in their tax preparation software for electronic and/or paper filing, must obtain approval from the 
NCDOR. To do so you must complete this LOI to be able to view and/or download the required information needed for 
testing and approval. Test Submissions for electronic and/or paper forms will not be reviewed until the LOI has been 
received and approved. 
 
Submission 
 •     Completed LOIs should be emailed to AllAboutForms@ncdor.gov as web-filled PDFs.  
 •     By submitting this LOI to the NCDOR you agree to meet our standards for software provider registration, tax 
       preparation software, and substitute forms.  If you do not meet the standards and requirements explained in 
       this LOI or provide an incomplete form, we may deny your application or revoke your approved Provider status 
       and reject all electronic and/or paper returns submitted using your products.  
 •     An LOI should be submitted for each product unless multiple products share the same calculation engine.  In this 
       case, one LOI can be submitted for all products that share the same calculation engine. 
 
Note:  If you are a new Provider who has not filed city/state income tax returns with any city or state agencies, you must 
have passed assurance testing with the IRS.  Attach documentation from the IRS demonstrating you have successfully 
tested with the IRS.   
 
Important Dates  
The NCDOR has important key dates to ensure we are ready for the filing season and taxpayers can file accurate and 
timely tax returns.  Please note the following key dates:  
 
   Description                             Date 
   LOI Submission Due                      September 9, 2024 
                                           Note: If you only support e-File, the due date is November 1, 2024 
   ATS Testing Start Date                  November 15, 2024 (Target start date) 
   e-File Initial Tests Due                December 31, 2024 
   e-File Test Approvals Due               March 14, 2025 
   Paper Substitute Tax Forms Tests        See Provider Required Approval Dates on the SES 
 
Registration  
  Check this box if this LOI is for both e-File and Substitute Tax Forms. 
Amended Letter of Intent  
  Check this box if this is an amended Letter of Intent. 
NOTE: An amended Letter of Intent is no longer required for contact information changes, if you have contact updates, 
please email those to  AllAboutForms@ncdor.gov.  
 
Reason for Amendment:  

                                                           2                                                   

Company Information  
List your company information.   
 
Name of Company                                    Product Name              Software Developer Code (e-File only) 
                                                                                         
DBA Name                                           NACTP Vendor ID            
                                                               
Address                                            Product Address/URL       Company FEIN 
                                                                                        
City                                               State                     Zip Code 
                                                                                        
List your other product names using the same calculation engines here: Note: The same calculation engine is defined as 
products that support the same forms, schedules, and tax calculations. 
           
IRS Issued Electronic Identification Numbers 
List your IRS electronic identification numbers.   

                                 EFIN(s)                                      ETIN(s) 

 Individual Tax                  Test EFIN(s):                                Test ETIN(s):            

                                 Production EFIN(s):                          Production ETIN(s):            

 Business Tax                    Test EFIN(s):                                Test ETIN(s):            

                                 Production EFIN(s):                          Production ETIN(s):            

Contact Information  
List the contact information for each area identified.    
 
Regulatory/Compliance Contact                      Phone                     Email Address 
                                                                                        
Secondary Regulatory/Compliance Contact            Phone                     Email Address 
                                                                                        
Primary Individual MeF Contact                     Phone                     Email Address 
                                                                                        
Secondary Individual MeF Contact                   Phone                     Email Address 
                                                                                        
Primary Corporate MeF Contact                      Phone                     Email Address 
                                                                                        
Secondary Corporate MeF Contact                    Phone                     Email Address 
                                                                                        
                                                               3                                              

Primary Partnership MeF Contact              Phone                          Email Address 
                                                                                       
Secondary Partnership MeF Contact            Phone                          Email Address 
                                                                                       
Primary Fiduciary (Estate/Trust) MeF Contact Phone                          Email Address 
                                                                                       
Secondary Fiduciary (Estate/Trust) MeF Contact Phone                        Email Address 
                                                                                       
Primary Leads Reporting Contact              Phone                          Email Address 
                                                                                       
Secondary Leads Reporting Contact            Phone                          Email Address 
                                                                                       
Substitute Tax Forms Registration  
Complete this section only if your product will provide substitute forms.   
 
Agency Substitute Forms Software Number (leave blank if a new provider) 
           
Primary Individual Forms Contact             Phone        Email Address 
                                                                     
Secondary Individual Forms Contact           Phone        Email Address 
                                                                     
Primary Business Forms Contact               Phone        Email Address 
                                                                     
Secondary Business Forms Contact             Phone        Email Address 
                                                                     
Primary Forms Executive Manager              Phone        Email Address 
                                                                     
Note: If you have separate contacts for each business tax type, please list them by tax type on a separate sheet and 
attach it to this submission. 

                                                        4                                  

Software Products and Tax Types Supported 
Check all that apply.   
 
  Type of Software Product Supported 
  DIY/consumer (Web-Based)                      
  DIY/consumer (Desktop)                        
  Professional/paid preparer (Web-Based)        
  Professional/paid preparer (Desktop)          
  
  Tax Types Supported  
  Corporation/Franchise Tax (C-Corp & S-Corp)   e-File                        Substitute Forms  
  Estate/Trust/Fiduciary Tax                    e-File                        Substitute Forms 
  Individual Income Tax                         e-File                        Substitute Forms 
  Partnership Tax                               e-File                        Substitute Forms 
  Sales and Use Tax                                                           Substitute Forms       
  Withholding Tax                                                             Substitute Forms       
 
  Rebranded Software Products  
Complete this section only if your product is rebranded. 

For software to be considered rebranded, changes cannot be made to the software requirements and output(s).  As the 
software company selling and/or licensing your product to a third-party, it is your responsibility to make sure the 
rebranded product reflects the current software requirements and output(s). List each of your rebranded products 
below.   
 
  Rebranded Product Name            ETIN (if applicable)  Contact Person     Phone                   Email Address 
                                                                                                               
  Rebranded Product Name            ETIN (if applicable)  Contact Person     Phone                   Email Address 
                                                                                                               
  Rebranded Product Name            ETIN (if applicable)  Contact Person     Phone                   Email Address 
                                                                                                               
  Rebranded Product Name            ETIN (if applicable)  Contact Person     Phone                   Email Address 
                                                                                                                
  Rebranded Product Name            ETIN (if applicable)  Contact Person     Phone                   Email Address 
                                                                                                                
Attach additional sheets if needed. 
 
For Rebranded Products, the NCDOR has the following requirements: 
  •          Rebranded Products are not required to complete e-File ATS/substitute form approval.  
                               
                                                         5                                                           

e-File Mandates or Requirements  
The NCDOR does not have any electronic filing mandates for MeF tax schedules. 
 
The NCDOR has mandated the electronic filing of forms NC-3 and all required W2 and 1099 wage and income 
statements. The registration process to electronically file these forms can be found on our website at ncdor.gov/taxes-
forms/withholding-tax/enc3. 

Forms and Schedules Supported by Tax Type (check all that apply) 

Check the boxes of the forms and schedules your company supports. 
 Forms and Schedules                                                                    e-File         Substitute 
                                                                                                       Forms 
 Individual Income Tax Forms 
 D-400  –Individual Income Tax Return                                                                   
 D-400 Schedule S  –N.C. Adjustments for Individuals                                                    
 D-400 Schedule A  –N.C. Itemized Deduction                                                             
 D-400 Schedule PN  –Part-Year Resident and Nonresident Schedule                                        
 D-400 Schedule PN-1  –Other Additions and Other Deductions                                             
 D-400TC  –Individual Income Tax Credit                                                                 
 D-400 Schedule AM  –Amended Schedule                                                                   
 D-410  –Application for Extension for Filing Individual Income Tax Return                              
 NC-40  –Individual Estimated Income Tax                                                                
 D-400V  –Individual Income Payment Voucher                                                             
 D-400V  –Amended Individual Income Payment Voucher                                                     
 D-422  –Underpayment of Estimated Tax by Individuals (  Substitute Forms only)                         
 D-422A  –Annualized Income Installment Worksheet (      Substitute Forms only)                         
 Estate/Trust/Fiduciary Tax Forms 
 D-407  –Estates and Trusts Income Tax Return                                                           
 D-407TC  –Estates and Trusts Tax Credit Summary                                                        
 D-407 NC K-1   – Beneficiary’s Share of NC Income, Adjustments and Credits                             
 D-407V  –Estates and Trusts Payment Voucher                                                            
 D-407V Amended - Amended Estates and Trusts Payment Voucher                                            
 D-410P  –Application for Extension for Filing Partnership, Estate or Trust Tax Return                  
 Partnership Tax Forms 
 D-403  –Partnership Income Tax Return                                                                  
 D-403TC  –Partnership Tax Credit Summary                                                               
 D-410P  –Application for Extension for Filing Partnership, Estate or Trust Tax Return                  
 D-403V  –Partnership Income Payment Voucher                                                            
 D-403V Amended  –Amended Partnership Income Payment Voucher                                            

                                                            6                                                 

 Forms and Schedules                                                              e-File Substitute 
                                                                                         Forms 
 D-403 NC K-1   – Partner’s Share of NC Income, Adjustments and Credits                   
 NC-40 PTE  –Taxed Partnership Estimated Income Tax   (Substitute Forms only)             
 NC-NPA  –Nonresident Partner Affirmation (  Substitute Forms only)                       
 Corporate and Franchise Tax Forms 
 CD-401S  –S-Corporation Tax Return                                                       
 CD-405  –C-Corporation Tax Return                                                        
 CD-405 CW  –Combined Corporate Income Tax Worksheet                                      
 CD-425  –Corporate Tax Credit Summary                                                    
 CD-V  –Franchise and Corporate Payment Vouchers                                          
 CD-V  –Amended Franchise and Corporate Payment Vouchers                                  
 CD-418  –Cooperative or Mutual Association 2022 ( Substitute Forms only)                 
 CD-419  –Application for Extension for Franchise and Corporate Income Tax                
 CD-429  –Corporate Estimated Income Tax                                                  
 CD-429B  –Underpayment of Estimated Tax by C-Corporations (  Substitute Forms            
 only) 
 NC K-1 CD-401S   – Shareholder’s Share of NC Income, Adjustments and Credits             
 CD-429 PTE  –Taxed S Corporation Estimated Income Tax  (Substitute Forms only)           
 NC-NA  –Nonresident Shareholder Agreement (   Substitute Forms only)                     
 Sales and Use Tax Forms 
 E-500  –Sales and Use Tax Return                                                         
 E-536  –Schedule of County Sales and Use Taxes                                           
 E-500E  –Combined General Rate Sales and Use Tax Return                                  
 E-500F  –Motor Vehicle Lease and Rental Tax Return                                       
 E-500G  –Scrap Tire Disposal Tax Return                                                  
 E-500H  –White Goods Disposal Tax Return                                                 
 E-500K  –Solid Waste Disposal Tax Return                                                 
 E-500L  –Service Charge/Prepaid Wireless Telecommunications Return                       
 E-585  –Nonprofit & Governmental Entity Claim for Refund State and County Sales          
 and Use Taxes 
 E-585S  –Incentive Claim for Refund State and County Sales and Use Taxes                 
 E-536R  –Schedule of County Sales & Use Tax Claim for Refund                             
 E-588  –Business Claim for Refund State and County Sales and Use Taxes                   
 E-595E  –Streamlined Sales and Use Tax Agreement                                         
 Withholding Tax Forms 
 NC-3  –Annual Withholding Reconciliation (electronic filing mandate)                     
 NC-5  –Withholding Return                                                                
 NC-5A  –Applied For Status Withholding Return                                            
                                                          7                                     

  Forms and Schedules                                                               e-File Substitute 
                                                                                            Forms 
  NC-5X  –Amended Withholding Return                                                         
  NC-5P  –Withholding Payment Voucher                                                        
  NC-5PA  –Applied For Status Withholding Payment Voucher                                    
  NC-5PX  –Amended Withholding Payment Voucher                                               
  NC-5Q  –Quarterly Income Tax Withholding Return                                            
  NC-3X  –Amended Annual Withholding Reconciliation                                          
  NC-4   – Employee’s Withholding Allowance Certificate                                      
  NC-4EZ   – Employee’s Withholding Allowance Certificate                                    
  NC-4 NRA   – Nonresident Alien Employee’s Withholding Allowance Certificate                
  NC-4P  –Withholding Certificate for Pension or Annuity Payments                            
  Common/Shared Forms Supported                                                             
  NC-429B PTE  –Underpayment of Estimated Tax by Taxed Pass-Through Entities.                
  (Substitute Forms only) 
  NC-478  –Summary of Tax Credits Limited to 50% of Tax                                      
  NC-478 Pass Through  –Pass-through Schedule for NC-478 Series                              
  NC-EDU  –North Carolina Education Endowment Fund Contribution                              
  NC-NOL –Net Operating Loss Worksheet                                                       
  NC-Rehab  –Historic Rehabilitation Tax Credits                                             
  NC-PE  –N.C. Additions and Deductions for Pass-Through Entities, Estates, and              
  Trusts 
  NC-K1 Supplement Schedule   – Owner or Beneficiary’s Share of N.C. Additions and           
  Deductions  
  GEN-58  –Power of Attorney and Declaration of Representative                               
  GEN-58R  –Revoke a Power of Attorney and Declaration of Representative                    
  EFT-100C  –ACH Credit Payment Method Authorization Agreement                               
  EFT-100D  –ACH Debit Payment Method Authorization Agreement                                
  NC-BR  –Business Registration Application for Income Tax Withholding, Sales and            
  Use Tax and Other Taxes and Service Charge  
  *Reserved Lines for Additional Forms 
                                                                                             
*Reserved lines are held for the addition of new forms due to late legislation. The NCDOR will provide the form name and 
submission method for any new forms that are added, and instructions for submitting an amended LOI if relevant.           

                                                           8                                                      

Electronic Amended Returns 
The NCDOR requests you support electronic amended returns for those available through MeF.  Check the appropriate 
box below to indicate whether you support electronic filing of amended returns for each tax type listed. 
 Amended Returns                                                          Supported        Not Supported 
 Individual Income Tax                                                                      
 Estate/Trust/Fiduciary Tax                                                                 
 Partnership Tax                                                                            
 Corporate and Franchise Tax                                                                

Agency Requirements 
This section identifies agency requirements and expectations of new and existing Providers and software products.  
 
Issue Notification and Resolution Requirements   
This section represents the NCDOR issue notification and issue resolution standards.   
 1. If computation errors or variable data errors exist within the software or if production errors occur while 
    processing substitute forms, notify the NCDOR and customers in writing, within three (3) business days of 
    discovery of the error/issue.  Notification to the NCDOR shall be sent to AllAboutForms@ncdor.gov.  
    Notification shall be in the form of a corrective action plan. Providers shall comply with the notification and 
    issue resolution standards as set out below. 
    a.           Provide the NCDOR with a corrective action plan within three (3) business days after discovery of 
                 the error/issue that provides the following details: 
                       i.   Date when the error and/or issue was initially identified 
                       ii.  Date the error/issue will be corrected 
                       iii. Date when the update will be released 
                       iv.  Date when update was communicated to customer 
                       v.   Provide a copy of the customer communication 
    b.           Within ten (10) business days of the date the error recap email is sent by NCDOR, Provider must 
                 obtain form approval from NCDOR for corrected form(s) and/or resubmit an e-File submission to 
                 validate the correction. 
    c.           Failure to comply with any correction of computation errors or the variable data errors may result in 
                 the loss of software and/or forms approval and removal of the Provider and its products from the 
                 CDOR’s website. 
    d.           Providers must regression test software updates, code fixes, and error corrections to ensure the fix 
                 did not impact any other fields on either the electronic or paper return. 
    e.           Provide NCDOR with a copy of the communication to the taxpayers and/or tax professionals 
                 regarding the error/issue and resolution. 
 2. Notify the agency if any forms and/or payments you support are not ready during the filing season after 
    agency approval.  Submit this information via email to AllAboutForms@ncdor.gov and include the date the 
    electronic or paper product will be ready to submit. 
 3. Providers that execute this agreement are subject to the Identity Theft Protection Act (Chapter 75, Article 
    2A) of the North Carolina General Statutes.   Security breaches, as defined by Chapter 75, must be reported 
    to the Consumer Protection Division of the North Carolina Office of Attorney General.  For more 
    information, see Protect Your Business from ID Theft.  Providers must immediately notify the NCDOR by 

                                                 9                                                                 

          email at AllAboutForms@ncdor.gov of any known or suspected unauthorized access to or acquisition of 
          North Carolina taxpayer data. 
 
Production Return Submission Requirements 
All North Carolina tax forms generated fromProvider’s software must be e-Filed or printed from theProvider’s approved 
software or a subsequent product update.   
    1. Electronic submissions and paper tax returns must fully comply and meet the standards set forth in the 
          Modernized e-File Guide (MeF), Requirements for the Approval of Tax Forms document, and the LOI.  If 
          not, the electronic returns and paper returns will be rejected by the NCDOR. 
    2. The NCDOR does not endorse any software products that support the                                                                                   electronic filing and/or reproduction 
          of State forms. Therefore, Providers shall refrain from promoting and/or advertising software products as 
          endorsed by the NCDOR.  
    3. The NCDOR may include                                                                                        Providers’ name in communications used to inform tax practitioners and the 
          public about software products that comply or failed to comply with NCDOR guidelines and requirements 
          included in the MeF and requirements for the Approval of Tax Forms document.  
  
Substitute Tax Forms Requirements 
This section represents the NCDOR requirements for Substitute Tax Forms. Providers shall adhere to the following: 
    1. Submit all forms following the published form specifications, production details, and the current year 
          “Requirements for the Approval of Substitute Tax Forms”                                                                          document.  
    2. P       allroduce          aforms in           setspecified as listed thein “Requirements thefor Approval Substituteof Tax 
          Forms” document. 
    3. Prior to receiving approval for each North Carolina form indicated on the Letter of Intent, refrain from 
          selling, releasing, licensing, or distributing tax packages to customers without placing a semi-transparent 
          water mark on each unapproved form that states, “UNAPPROVED FORM: DO NOT FILE.”  This watermark is 
          to be printed diagonally across the form in bold, capital letters in Arial 60 pt. font.  Only approved current 
          year forms will not bear this watermark.  This watermark will enable the NCDOR to readily identify these 
          forms and reject them.  
    4. Providers who choose to support public NCDOR website forms are legally responsible for any 
          misstatements made on the forms.  

Product Updates 
Desktop Product users who attempt to file 10 or more business days after a production release must be required to 
download and apply the product update.   
 
Schemas   
Provider software must follow the schema requirements.  NCDOR schema requirements are available in the State 
Exchange System (SES).  
                                                                                                         
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Software Limitations 
Provide any software limitations to forms or schedules you support during ATS.  Failure to provide this information could 
delay the review of your test returns.  If additional space is needed, please attach additional page(s).  If there are 
additional limitations after completing the LOI, please provide them to NCTaxEfile@ncdor.gov before you begin ATS 
testing.   

Software Exceptions   
Provide any exceptions to forms or schedules you support based on the type of software during ATS.  Example, a DIY 
product does not support the same schedules as a professional product.  Failure to provide this information could delay 
the review of your test systems.   
 
Are there any differences in the forms you support based on the type of software?  If yes, please explain those 
differences as well. 

System Security Requirements 
The NCDOR does not prescribe the security requirements for your system.  You are responsible for implementing 
appropriate security measures to protect taxpayers and their information in your system.  You must apply security 
measures to protect taxpayer information in your system when it is on-line, off-line, at rest, and in transit.   
 
Testing and Submissions 
All e-File ATS and substitute forms tests submitted during the approval process must be created in, and originate from, 
the Provider’s actual software.  
                                  
                                   11                                                                                   

Customer Notices 
This section identifies information the NCDOR requires Providers to communicate to their customers.   

Disclosure and Use of Information Language Expectations   
Providers must include the following consent language with electronic filing software.   

 For Do-It-Yourself software:  
 By using a computer system and software to prepare and file my tax return(s) electronically, I consent to the 
 transmission of my return(s) and to the disclosure of all information about my use of the system and software 
 to the North Carolina Department of Revenue. 
  
 For Tax Professional software: 
 By using a computer system and software to prepare and file my client’s return(s), I consent to the transmission 
 of my client’s return(s) and to the disclosure of all information about my use of the system and software to the 
 North Carolina Department of Revenue.  
  
 For Business software: 
 By using a computer system and software to prepare and file this business tax return(s), I consent to the 
 transmission of the return(s) and to the disclosure of all information about the use of the system and software to 
 the North Carolina Department of Revenue.  
 
Required Screenshots 
An email will be sent to the Provider requesting screen shots that contain NCDOR required verbiage used within the 
software product. These screens shots must be submitted for both do-it-yourself and professional software products.  
The following screen shots are required before a product can be approved (Note: The verbiage applies to all tax types 
unless otherwise noted): 
 
Driver’s License (DL)/ID Card Expectations 
For e-File returns:  
The NCDOR requests the DL/ID card number be included with the return but will not reject the return if it is not 
included. All Do It Yourself (DIY) and Tax Professional software packages must include the statement below in your 
software. The statement should be displayed prominently within your software so that it is visible to customers.   
 Statement: To protect your identity and combat tax fraud, many state revenue agencies are requesting that 
 filers provide their driver’s license or state   -issued ID number. While providing this information is encouraged, it 
 is optional and not required to file your North Carolina taxes. 
 
Refund Expectations 
The NCDOR requires a statement for refund processing.  All Do It Yourself (DIY) and Tax Professional software packages 
must include the statement and URL below in your software. The statement should be displayed prominently within 
your software so that it is visible to customers. 
 URL: ncdor.gov/refund 
 
 Statement: You can get up to date information regarding refund processing and check the status of your refund 
 online at ncdor.gov/refund.  To view refund status information, you will be prompted to enter your Social 
 Security Number along with the exact amount of your refund.  You can also call our toll-free refund inquiry line at 
 1-877-252-4052, 24 hours a day, 7 days a week. 

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QR Code 
To help promote the use of the NCDOR  ’s electronic payment options via our website, NCDOR request Providers add a 
QR code to printed payment instruction documents that are provided to taxpayers. The QR code should direct the 
taxpayers to the NCDOR ’sFile and Pay webpage    (ncdor.gov/file-pay) for the applicable payment forms. The QR code 
should not be placed on vouchers and/or forms. The links for the QR Code will be available in the SES. 

Agency Questions 
General Questions 
 1. What refund products or payment methods do you offer your customers?  If you partner with an entity to 
    provide refunds, please provide the names, and bank routing numbers (RTNs) of each company.  Attach a 
    separate sheet if necessary. 
 
e-File Specific Questions 

    1. Do you support any of the following: (check all that apply) 
             a. Unlinked                                                  Yes            No        
             b. Foreign address                                           Yes            No        
             c. TPOS                                                      Yes            No        

    2. Will you offer a Free File Alliance (FFA) Product for TY 2024? If yes, please complete the information below 
       for product listing on the NCDOR’s website: 

             a. Free File Product Name ____________________________________________________________                   
                  
             b. Free File Contact Name ____________________________________________________________  
                  
             c. Contact Phone Number ____________________________________________________________  
                  
             d. Contact Email Address ____________________________________________________________            
                  
                                                          13                                                    

 3. Would you like to opt-in to receive a personalized MeF business rule and reject report card from the 
    NCDOR?  If yes, please complete the contact information below: 
    Note: This will only be available after May 31, 2025, for approved Providers that had submissions.  
        a.        Yes 
        b.        No 
     
    Contact Name ____________________________________________________________  
 
    Contact Email Address ______________________________________________________ 
 
Forms Specific Questions 

 1. Do you place product identification in software that prints on the substitute tax forms? 
        a.           Yes 
        b.        No 

 2. How are NCDOR form instructions presented in your software? 
        a.        Printable option with the form 
        b.        Link in software 
        c.        Link to the NCDOR ’swebsite 
     
 3. How will your forms be submitted to NCDOR for approval? 
        a.        PDF/E-mail (Identify which PDF maker is being used) ___________________________ 
        b.        Express Mail 

 4. What software program will your company use to develop substitute tax forms? 

 5. Has your operating system changed since TY2023? 
        a.        Yes 
        b.        No 
 
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Acknowledgments and Signature 
By signing this agreement, I agree to provide true, accurate, current, and complete information and my company 
agrees to all the requirements listed in this document.   
 
The North Carolina Department of Revenue reserves the right to deny, suspend or terminate my company’s ability to 
submit forms/returns. 
 
 AUTHORIZED REPRESENTATIVE PRINTED NAME AUTHORIZED REPRESENTATIVE EMAIL ADDRESS 
                                                   
 AUTHORIZED REPRESENTATIVE SIGNATURE    AUTHORIZED REPRESENTATIVE PHONE                      DATE 
                                        NUMBER                                                          
                                                   
                                                                                             SUBMIT

                                                          15                                                    

Authorized Access to the State Exchange System 

Access to the State Exchange System should be limited to those with a business need. 
 
Provide information for each employee you are authorizing for access to the State Exchange System. The tax type box 
should include all the tax types individuals are authorized to access.   
 
NOTE: Include all authorized individuals, even if listed above in the contact sections. 
 
 First and Last Name   Phone Number                                      Email Address 
                                                                                     
                       Authorized access                                 Tax types  
                        e-File           Substitute Forms                  Common/Shared 
                                                                           Corporate 
                                                                           Estates and Trusts 
                                                                           Individual Income 
                                                                           Partnership 
                                                                           Sales and Use 
                                                                           Withholding 
                                                                          
 First and Last Name   Phone Number                                      Email Address 
                                                                                     
                       Authorized access                                 Tax types  
                        e-File           Substitute Forms                  Common/Shared 
                                                                           Corporate 
                                                                           Estates and Trusts 
                                                                           Individual Income 
                                                                           Partnership 
                                                                           Sales and Use 
                                                                           Withholding 
                                                                          
 First and Last Name   Phone Number                                      Email Address 
                                                                                     
                       Authorized access                                 Tax types  
                        e-File           Substitute Forms                  Common/Shared 
                                                                           Corporate 
                                                                           Estates and Trusts 
                                                                           Individual Income 
                                                                           Partnership 
                                                                           Sales and Use 
                                                                           Withholding 
                                                                          
                                               16                                              

 First and Last Name   Phone Number                       Email Address 
                                                                      
                       Authorized access                  Tax types  
                        e-File           Substitute Forms   Common/Shared 
                                                            Corporate 
                                                            Estates and Trusts 
                                                            Individual Income 
                                                            Partnership 
                                                            Sales and Use 
                                                            Withholding 
                                                           
 First and Last Name   Phone Number                       Email Address 
                                                                      
                       Authorized access                  Tax types  
                        e-File           Substitute Forms   Common/Shared 
                                                            Corporate 
                                                            Estates and Trusts 
                                                            Individual Income 
                                                            Partnership 
                                                            Sales and Use 
                                                            Withholding 
                                                           
 First and Last Name   Phone Number                       Email Address 
                                                                      
                       Authorized access                  Tax types  
                        e-File           Substitute Forms   Common/Shared 
                                                            Corporate 
                                                            Estates and Trusts 
                                                            Individual Income 
                                                            Partnership 
                                                            Sales and Use 
                                                            Withholding 
                                                           
 First and Last Name   Phone Number                       Email Address 
                                                                      
                       Authorized access                  Tax types  
                        e-File           Substitute Forms   Common/Shared 
                                                            Corporate 
                                                            Estates and Trusts 
                                                            Individual Income 
                                                            Partnership 
                                                            Sales and Use 
                                                            Withholding 
                                                           
                                         17                                     

 First and Last Name  Phone Number                       Email Address 
                                                                     
                      Authorized access                  Tax types  
                       e-File           Substitute Forms   Common/Shared 
                                                           Corporate 
                                                           Estates and Trusts 
                                                           Individual Income 
                                                           Partnership 
                                                           Sales and Use 
                                                           Withholding 
                                                          
                                        18