Main Navigation
Form BOE-555-EFT Fillable Authorization Agreement for Electronic Funds Transfer (EFT)
(all forms fillable on Windows, Mac, Android tablets, and iPad using Adobe Reader XI)((date)) (BANK NAME) (BOE ACCOUNT NUMBER) (Business phone number area code ( )) (clear) CLEAR (CONTACT PERSON) (Contact phone number area code ( )) (date) (DATE) (DBA (doing business as)) (digit 1 of bank account number) (digit 1 of routing number) (digit 10 of bank account number) (digit 11 of bank account number) (digit 12 of bank account number) (digit 13 of bank account number) (digit 14 of bank account number) (digit 15 of bank account number) (digit 16 of bank account number) (digit 17 of bank account number) (digit 2 of bank account number) (digit 2 of routing number) (digit 3 of bank account number) (digit 3 of routing number) (digit 4 of bank account number) (digit 4 of routing number) (digit 5 of bank account number) (digit 5 of routing number) (digit 6 of bank account number) (digit 6 of routing number) (digit 7 of bank account number) (digit 7 of routing number) (digit 8 of bank account number) (digit 8 of routing number) (digit 9 of bank account number) (digit 9 of routing number) (first three number of phone number) (last four number of phone number) (not to exceed 17 digits) (print) PRINT (requires 9 digits) (TAXPAYER NAME) (TITLE) (TXP) and may only be initiated for the EFT tax payments to the State Board of Equalization provided for by statute (Type or Print in Ink) 1 EFT Start Date for New Accounts 1 Routing Number 2 Bank Account Number 2 Withdrawal Information 3 Changing Your Payment Method (ACH Debit vs ACH Credit) 3 Check Number 4 New Bank Account or Routing Number ACH CreditThe State Board of Equalization is hereby requested to grant authority for the above named taxpayer to initiate ACH credit transactions to BANKNAMETYPEOFACCOUNTCheckingSavingsBANKACCOUNTNUMBER(nottoexceed17digits) been approved and indicates the ending date for making EFT payments BOE 555 EFT (BACK) REV 6 (4 06) BOE 555 EFT (FRONT) REV 6 (4 06) STATE OF CALIFORNIAAUTHORIZATION AGREEMENT FORBOARD OF EQUALIZATIONELECTRONIC FUNDS TRANSFER (EFT) BOEACCOUNTNUMBER box and complete every block of information for the method selected Change bank account on Change contact name or phone number Change EFT reporting method Complete all blocks in this section Your BOE account number is required (for example 30 123456) Complete and sign either Section II or III below (not both) Complete and sign one of these sections not both Complete Section II if you select ACH Debit or Section III if you select ACH Credit After making your decision please check the appropriate CONTACTPERSONCONTACTPHONENUMBER DBA(doingbusinessas)BUSINESSPHONENUMBER General Graphic of voided check showing 1 Routing Number (requires 9 digits) 2 Bank Account Number (not to exceed 17 digits) 3 Check Number If the ACH Debit method is chosen a voided check must be attached to the completed form Your voided check will verify bank account and If you are submitting an authorization agreement form to change from ACH Debit to ACH Credit or vice versa you must continue to use your current report If you are submitting an authorization agreement form to change your bank account or routing number you will not receive a confirmation letter If you qualify and wish to withdraw you must make your request in writing (this is not true if you are closing out your account) Send your letter to EFT Group Important Information IMPORTANT:IfyouhaveselectedtheACHDebitoption youmustattachavoidedcheckfortheaccounttobedebited Yourvoidedcheckwill ing method until you are notified in writing by the Board that your request has been approved A confirmation letter will be mailed to you once your method instead of the voided check Instructions for Completing the EFT Authorization Agreement Form Make a copy for your records New EFT account of payment has been changed Once you are registered you cannot withdraw from the EFT program unless your average monthly tax over a twelve month period is less than $10 000 P O Box 942879 Sacramento CA 94279 0035 You must continue to make payments by EFT until the Board notifies you in writing that your request has participant until the State Board of Equalization and I mutually agree to terminate my participation in the EFT program Please type or print clearly Return to the State Board of Equalization within ten days from the date received Make a copy for your records PleaseCheckAppropriateBoxes: Remember to mark the word void across the face of the check that you return with the authorization agreement Return to:Board of Equalization Attn EFT Group P O Box 942879 Sacramento CA 94279 0035or fax to 916 322 8457For EFT assistance call 916 327 4229 routing numbers ROUTINGNUMBER: Section I SECTION IIACH DebitTheStateBoardofEqualizationisherebyauthorizedtoinitiatedebitentriestothebankaccountidentifiedbelowandthebankisauthorized SECTION III (Do not complete if you have completed Section II above ) SECTION ITAXPAYERNAME Sections II and III See reverse for instructions SIGNATURETITLE SIGNATURETITLEDATE The example of a voided check shown below indicates where to locate the routing number for your bank and your bank account number the State Board of Equalization s bank account These payments must be in the NACHA CCD+ format using the Tax Payment Convention to debit such account This authority is to remain in full force until EFT payments are no longer required by statute or if I am a voluntary to pay by EFT before your approved start date verifybankaccountandroutingnumbers Ifyouareunabletoprovideavoidedcheck abankspecificationsheetmaybeused You will be notified in writing if your agreement is approved Your confirmation letter will indicate when you must start making EFT payments DO NOT attempt