TERMINATING YOUR ENROLLMENT - EFTPS

1 TERMINATING your ENROLLMENT You can terminate your ENROLLMENT by logging in to your account at If you are unable to log-in to your account or unable to complete the process on-line, complete this form and fax it to You must sign the form for your request to be processed. If you have payments scheduled with this account, we will cancel any that are eligible to be cancelled and process those not eligible for cancellation. To be eligible for cancellation, the payments have to be scheduled to be settled 2 business days or more into the future from the date the cancellation request is entered into the system. If the information you submit matches more than one ENROLLMENT for the EIN/SSN, we will cancel only the oldest ENROLLMENT . You will receive a letter via U.

2 S. Mail in 7-10 days that either confirms this termination or advises you if there is a problem with your request. DATE: EIN/SSN (required): Please provide: ENROLLMENT NUMBER (18 digits): OR LAST 4 DIGITS OF BANK ACCOUNT NUMBER: TAXPAYER NAME: CONTACT NAME: STREET ADDRESS: SUITE/DEP: CITY: STATE: ZIP/POSTAL CODE: COUNTRY: PHONE NUMBER: PRINT NAME: SIGNATURE: DATE: TITLE.

3 QUESTIONS? EFTPS Customer Service is available 24/7 at Enroll_Term 11-12