FORM EFT Please Complete: Tax Type: Check type(s ...

COM/RAD-072 Rev. 10-10 FORM EFTC omptroller of MarylandAuthorization agreement forElectronic Funds Transfers New Revision: Effective Date _____Please allow 10 business days for revisionsTax Type: Check type(s ) Withholding Corporation Income Tax (Pass Through Entities are not eligible) Sales & Use Tax Motor Fuel TaxesACONTACTPERSON(S)BACHDEBITCACHCREDI TThis section must be completed by all taxpayersPrimary EFT contact person _____Address _____City State ZIP code Telephone numberSecondary EFT contact person _____Address _____City State ZIP code Telephone number_____ Signature of owner, partner, or officer Title DateCHOOSE ONLY ONE OF THE TWO PAYMENT OPTIONS BELOWThis section to be completed only if you choose the ACH DEBIT OPTIONIf ACH Debit is chosen, you authorize the comptroller of maryland to present the debit entries to your bank for the tax identified above. Only you can initiate a debit by calling the state s service bureau and indicating the amount of tax to be paid by electronic funds name _____Bank address _____City State Zip CodeBank account number _____ Bank routing/transfer number _____ Checking Savings_____Signature of owner, partner, or officer Title DateThis section to be completed only if you choose the ACH CREDIT OPTIONAn AUTHORIZED REPRESENTATIVE of your bank must complete and sign this section confirming that you and your bank are capable o

COM/RAD-072 Rev. 10-10. FORM EFT. Comptroller of Maryland. Authorization Agreement for Electronic Funds Transfers New Revision: Effective Date _____

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  Agreement, Electronic, Maryland, Authorization, Comptroller, Comptroller of maryland, Authorization agreement for electronic

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