County of Fairfax, Virginia To protect and enrich the quality of life for the people, neighborhoods and diverse communities of Fairfax County Thank you for your interest in the Fairfax County Electronic Funds Transfer (EFT) program. The EFT program is an automated payment agreement designed to make paying your taxes easy, convenient, and hassle-free. To participate, you will need to complete the following form and provide a voided blank check. Completion of this contract authorizes the Department of Tax Administration (DTA) to deduct agreed upon payment(s) from your financial institution. Please read the details below before committing to the program: th th 1. Real estate tax is due July 28 and December 5 . Personal property tax is due October 5. For vehicles st th moved into the county after July 1 , personal property tax is due February 15 of the following calendar year. 2. You may choose to pay one or more real estate and/or personal property tax accounts. Deductions may be made monthly, quarterly, or as one lump sum. 3. Electronic deductions will continue in the amount and frequency according to your completed application form. If you wish to cancel your plan, add or remove property (to include purchase of new vehicle), or change the amount or frequency of deductions, you will need to notify DTA in writing 30 days in advance of the requested change. 4. You will receive a bill prior to the due date for any remaining balance not included in your plan. For real estate, any amount overpaid will be credited to the following installment, unless requested as a refund. For personal property, any amount overpaid will automatically be returned to you as a refund. If you are unsure of the amount due or need assistance determining the deduction amount, please call DTA at 703-222-8234. 5. DTA will not automatically send receipts for EFT deductions. Please retain a copy of your bank statement for receipt confirmation. Please return completed form and voided check to: Fairfax County Department of Tax Administration 12000 Government Center Parkway, Suite 223 Fairfax, VA 22035 For further assistance, please call 703-222-8234 or email DTAEFT@Fairfaxcounty.gov Sincerely, E. Scott Sizemore, Director Revenue Collection Division DEPARTMENT OF TAX ADMINISTRATION(DTA) REVENUE COLLECTION DIVISION 12000 Government Center Parkway, Suite 223 Fairfax, VA 22035 Phone: 703-222-8234 TTY:711; Fax: 703-324-2699 www.fairfaxcounty.gov/taxes |
Fairfax County Department of Tax Administration (DTA) FORM 12000 Government Center Parkway, Suite 223 ELECTRONIC FUNDS TRANSFER (EFT) EFT-PRE Rev 10-2013 Fairfax, VA 22035 AUTHORIZATION AGREEMENT Phone: 703-222-8234; TTY: 703-222-7594 Fax: 703-324-3935; www.fairfaxcounty.gov/taxes FOR THE PAYMENT REAL STATEE ANDOR /ERSONAL P ROPERTY P AXEST New EFT Authorization Modify Existing EFT Authorization – Desired Change: Update Information Change Deduction Amount or Date Add New Property Delete Property Name Business Name (If Applicable) Mailing Address City State Zip Code Home Phone Business Phone Cell Phone E-mail Name of Financial Institution Name on Bank Account Bank Account Type Checking (Attach Voided Check) Bank Account Number Nine Digit Routing Transit Number Savings (Attach Deposit Slip) Real Estate Tax Payments Please select the initiation date and frequency of the electronic debits for your real estate taxes (check one): st th Monthly: 1 of each month Monthly: 15 of each month st th Quarterly: 1 of January, April, July and October Quarterly: 15 of January, April, July and October Lump Sum – full tax amount is deducted on the due date (please leave the Debit Amount blank): st th nd th 1 Installment: July 28 2 Installment: December 5 Please enter the property address and deduction amount for each property: For DTA Use Only Property Address Debit Amount Map Number MTP $ $ $ $ Personal Property Tax Payments Please select the initiation date and frequency of the electronic debits for your personal property taxes (check one): st th Monthly: 1 of each month Monthly: 15 of each month st th Quarterly: 1 of January, April, July and October Quarterly: 15 of January, April, July and October th Lump Sum – full tax amount is deducted on October 5 (please leave the Debit Amount blank): Please enter the year/make/model and deduction amount for each vehicle: For DTA Use Only Year/Make/Model Debit Amount Property Number $ $ $ $ Funds will be debited from your bank account within two business days after the initiation date selected above. If the date selected falls on a holiday or weekend, the transaction will be initiated the next business day. Payments will be credited using the initiation date. All taxes must be paid in full on or before the due date. A bill will be sent before the due date for any tax not yet paid. Any outstanding balance after the due date will accrue interest and penalty. I certify that I have the authority to request an electronic funds withdrawal from the bank account identified above and I authorize Fairfax County, through a third party processor, to initiate and process electronic funds withdrawals from the above account. This EFT authorization agreement remains in effect until Fairfax County receives written notification from me of its termination. Cancellation of this EFT authorization agreement will take effect within 30 days of receiving a termination letter. My signature indicates that I understand and agree to the terms and conditions of this electronic funds transfer authorization agreement. Authorized Signature: _______________________________________________________ Date: __________________ Attach Voided Check or Deposit Slip Here Mail this form with voided check/deposit slip to: DTA, 12000 GOVERNMENT CENTER PKWY, SUITE 223, FAIRFAX, VA 22035 |