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: 
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   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 

                                                        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