GEN-53                                                                                             4
                                                                                                                                              6
Web-Fill                 Taxpayer Representative                                                                            PRINT             CLEAR
3-20
                         e-Business Center Access Authorization

Complete this form if you are a taxpayer representative (such as an accountant or payroll company representative) requesting view tax history and 
manage payment access to a taxpayer’s information in the NC Department of Revenue’s e-Business Center.  Note:  Representatives must first 
create an NCID user ID and password before submitting this form.  Please review the instructions for additional information.

Step 1.  Taxpayer Information  (Please type or print.) 

Legal Business or Owner’s Name:                                 Daytime Telephone Number:

Address:                                                        City, State and Zip:

Federal Employer Identification Number:                         or Proprietor’s Social Security Number

Step 2.  Taxpayer Representative Information

There is space provided for up to three representatives.  If you need to identify more, check here and attach a list to this form to identify 
the additional representatives.  Note that each taxpayer representative must include his or her signature and the date signed.  Taxpayer 
must sign all attachments.

Taxpayer Representative’s Name:

Taxpayer Representative’s Company Name:

Address:                                                        City, State and Zip:

Daytime Telephone Number:

Signature of Taxpayer Representative:                           Date:

Taxpayer Representative’s Name:

Taxpayer Representative’s Company Name:

Address:                                                        City, State and Zip:

Daytime Telephone Number:

Signature of Taxpayer Representative:                           Date:

Taxpayer Representative’s Name:

Taxpayer Representative’s Company Name:

Address:                                                        City, State and Zip:

Daytime Telephone Number:

Signature of Taxpayer Representative:                           Date:

Page 2
Gen. 53
Web-Fill
3-20
Step 3.  Tax Type and Period Begin Date

Select the tax type(s) and note the year or period begin date for which this authorization applies.

                           Type of Tax                                       Year/Period Begin Date

                        Alcoholic Beverage Tax - Beer

                        Alcoholic Beverage Tax - Fortified Wine

                        Alcoholic Beverage Tax - Unfortified Wine

                        Alcoholic Beverage Tax - Spirituous Liquor

                        Cigarette Tax - Resident

                        Cigarette Tax - Nonresident

                        Corporate Estimated Tax

                        Machinery and Equipment Tax

                        Other Tobacco Products Tax

                        Piped Natural Gas Excise Tax
                        (Repealed July 1, 2014)
                        Utility Franchise Tax - Electric
                        (Repealed July 1, 2014)
                        Utility Franchise Tax - Water and Sewer
                        (Repealed July 1, 2014)
                        Combined General Rate Sales and Use Tax
                        (Utility, Liquor, Gas and Other) formerly Utility
                        and Liquor Sales and Use Tax
                        Withholding Tax
                        (NC-5 and NC-5P)

Step 4.  Taxpayer Signature
I hereby certify that the taxpayer representative(s) identified should be granted the authority to view tax history and manage payment information within 
the NC Department of Revenue’s e-Business Center on my behalf.  This authorization may be revoked by me at any time (see form instructions for 
additional information).

Signature                                                                Print Name

Title                                                                    Date

                                        Fax Form Gen 53 to 919-715-1786 or mail to
                        North Carolina Department of Revenue,  PO Box 25000, Raleigh, NC 27640-0005 

 Gen-53 Instr.                                   General Instructions
 Web-Fill
 3-20
 
PURPOSE OF THIS FORM
The NC Department of Revenue’s e-Business Center is a secure web-based system within our website where you can file and pay taxes, store payment 
and business information for reuse, view history of online tax transactions and conduct other business with us. This form is used to grant access to a 
taxpayer representative (such as an accountant  or payroll company representative)  to view tax history and manage payment information for  a taxpayer  
in the e-Business Center.  Note:  Representatives must first create an NCID user ID and password before submitting this form.   

AUTHORITY GRANTED
The authority granted by this form is effective beginning with the period indicated in Step 3  and continues indefinitely unless revoked by the taxpayer or 
taxpayer representative. 

REVOKING THE AUTHORIZATION 
The taxpayer can revoke the taxpayer representative authorization granted on this form at any time by contacting the Department in writing. 
The taxpayer can:
 •  Write “Revoke” at the top of a copy of this form and sign under the original signature, or
 •  The taxpayer can write a letter requesting revocation and submit it to the NC Department of Revenue at PO Box 25000, Raleigh, NC 27640-0005 
 or fax it to 919-715-1786. The statement of revocation must be signed by the taxpayer.
 If the taxpayer wants to appoint a new taxpayer representative, the taxpayer can submit a new Taxpayer Representative e-Business Center Access 
Authorization to the same address.  It is the responsibility of the taxpayer to advise the NC Department of Revenue if access authorization information has 
changed.  
 A taxpayer representative can withdraw from representation by filing a statement with the NC Department of Revenue. The statement must be signed and 
dated by the representative and include the name and address of the taxpayer(s) and a statement revoking the e-Business Center access authorization. 
Include a copy of the original Taxpayer Representative e-Business Center Access Authorization, if available.

 DEFINITIONS
 Taxpayer – The business which authorizes  the taxpayer representative to view its tax history and manage its payment information in the e-Business 
Center.         
 Taxpayer Representative - A third party individual such as an attorney, an accountant, or a payroll company representative that is hired by a  taxpayer 
to represent it  on tax matters that might include filing tax returns and paying the tax and viewing copies of tax returns. The taxpayer representative is  
independent of the  taxpayer.
 Taxpayer Representative’s  Company Name – The company that employs the taxpayer representative, if applicable.
 View Tax History -  This access allows you to view returns and/or payments made online using the e-Business Center. 
 Manage Payment Information – This access  allows you to save and update payment information in the e-Business Center  for online payment of tax. 
The payment types include bank draft, and Mastercard and Visa credit/ debit card.

 STEP 1:  TAXPAYER INFORMATION INSTRUCTIONS
 •  Enter the taxpayer business’ legal name, or the owner’s name if the business is a sole proprietorship, telephone number and address.
 •  Federal Employer Identification Number or Social Security Number.
     -  If the business is a corporation, provide the Federal Employer Identification Number.   
     -  If the business is a sole proprietorship, provide the owner’s Social Security Number.

STEP 2:  TAXPAYER REPRESENTATIVE INFORMATION 
 •  Enter the taxpayer representative’s name, taxpayer representative’s company name, address and telephone number.  Note: Only individuals may 
 be named as representatives.
 •  The taxpayer representative signs and dates form here.
 •  There is space provided on the form for up to three representatives.  If you need to identify more, check the box and attach a list to the form to 
 identify additional representatives.  Note that each taxpayer representative must include their signature and the date signed.
 •  All representatives must first create an NCID user ID and password before submitting this form.  If you submit Form GEN-53 without first registering 
 for an NCID, the form cannot be processed and will be returned to you.  Instructions for creating an NCID are available on the Department’s website 
 at www.ncdor.gov.

STEP 3:  TAX TYPE AND PERIOD BEGIN DATE 
Enter the tax type(s) and the period begin date(s) associated with that tax type for which the taxpayer representative is being granted access. For example, 
if you are a monthly withholding taxpayer and you are granting access to a taxpayer representative beginning with the February 01, 2009 period, select the 
withholding tax type and enter 02-01-09 (Format: mm-dd-yy) in the period begin date field. 

STEP 4:  TAXPAYER SIGNATURE
The taxpayer signs here to grant view tax history and manage payment information in the Department’s e-Business Center to the taxpayer representative.
 •  If the taxpayer is a sole proprietorship, the owner must sign.  
 •  If the taxpayer is a corporation, an authorized officer must sign. 
 •  If the taxpayer is a partnership or a limited liability company (LLC), an authorized partner or member must sign. 
 •  Taxpayers must sign all attachments, if any.