Reset Form
Michigan Department of Treasury
4515 (Rev. 12-17)
Electronic Funds Transfer (EFT) - Account Update
This form is intended for accounts currently registered for EFT debit filing.  Complete the requested information if you choose to add or delete a tax to be paid using EFT.
PART 1: ACCOUNT INFORMATION
Company Name                                             User ID Code (5 or 6 digits)

                                                         Taxpayer Identification Number

Address                                                  E-Mail Address

City                                              State  ZIP Code                                               Contact Person Telephone Number

Contact Person                                                                                                  Contact Person Fax Number

PART 2: TAX INFORMATION
Check the appropriate box to add or delete a tax to be remitted by EFT debit (check all that apply).  
ADD     DELETE                                                 ADD                                        DELETE
                 Single Business Tax Annual (02671)                                                       Motor Fuel (05000)
                 Michigan Business Tax Extension (02355)                                                  IFTA (05900)
                 Michigan Business Tax Annual (02655)                                                     Tobacco Products Tax (07300)
                 Corporate Income Tax Annual (02670)                                                      Tobacco Products Proposed Adjustments (07311)
                 Corporate Income Tax Estimate (02170)                                                    Tobacco License Fee/Equity Assessment (07321)
                 Corporate Income Tax Extensions (02370)                                                  Tobacco Stamp Fee (07331)

Date you wish to begin making EFT debit payments for the tax type(s) checked above. Treasury will try to complete processing by the date provided.

PART 3: AUTHORIZATION (FOR EFT DEBIT FILERS ONLY)
If you are interested in making EFT debit payments for the taxes selected above, you must give written permission to access the bank account you 
have designated to withdraw your authorized funds.  You may do this by providing your signature below.
I authorize the State of Michigan and its authorized contractor to make variable withdrawals by electronic transfer from the designated financial institution and account.  
I understand that only the withdrawals I authorize will be made and that this process is protected by a password and a user code. I understand that I may cancel this 
authorization at any time by sending a written notice to the address noted below. I agree to comply with the National Automated Clearing House Association Rules and 
Regulations about electronic transfers as they exist on the date of my signature on this form or as subsequently adopted, amended, or repealed. Michigan law governs 
electronic funds transactions authorized by this agreement in all respects except as otherwise superseded by federal law. If multiple signers are required to authorize a 
withdrawal of funds, all must sign this form. 
Signature of Responsible Officer                         Title                                                        Date

PART 4: CERTIFICATION
Complete this section if you are not currently registered to pay sales tax, use tax, or withholding tax by EFT, and have checked the box in Section 2 to 
begin remitting one or more of these taxes by EFT.
Please be aware of officer, member or partner liability as provided in Michigan Compiled Laws 205.27a(5):
“If a corporation, limited liability company, limited liability partnership, partnership, or limited partnership liable for taxes administered under this 
act fails for any reason to file the required returns or pay the tax due, any of its officers, members, managers, or partners who the department 
determines, based on either an audit or an investigation, have control or supervision of, or responsibility for, making the returns or payments is 
personally liable for the failure.......”
Signature of Corporate Officer, Partner, or Member responsible for reporting and/or paying Michigan taxes             Date

Type or Print Name                                       Title

If you have any questions, contact the Michigan Department of Treasury at 517-636-6925. You may mail the completed form to: 
Michigan Department of Treasury, Registration Unit, PO Box 30778, Lansing MI 48909. Allow four weeks for processing.