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Electronic Funds Transfer Program Revision Request For Automatic Clearing House Debit Account Payments - New Jersey

Electronic Funds Transfer Program Revision Request For Automatic Clearing House Debit Account Payments Form. This is a New Jersey form and can be used in Business Registration Secretary Of State .
 Fillable pdf Last Modified 3/25/2010
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Rev 6/11/04 State of New Jersey DEPARTMENT OF THE TREASURY DIVISION OF REVENUE PO Box 628 TRENTON, NJ 08646-0628 James E. McGreevey John E McCormac, CPA State Treasurer Governor NEW JERSEY ELECTRONIC FUNDS TRANSFER (EFT) PROGRAM REVISION REQUEST for AUTOMATED CLEARING HOUSE (ACH) DEBIT ACCOOUNT PAYMENTS Dear Taxpayer: Please follow the steps below to ensure the proper revision of bank account information. This will allow the change indicated to be made quickly and accurately, while minimizing the chance of a failed electron ic tax payment. Complete the information below and fax it to the Division of Revenue at (609) 292-1777 or mail it to: New Jersey Division of Revenue, EFT Unit, PO Box 191, Trenton, NJ 08646-0191, Attn: Brenda Adams. For questions, please call Brenda Adams at (609) 777-4588 or (609) 984-9830. Reach the EFT Unit via email atinfo@revenue.state.nj.us . The Divisions web address is http://www.state.nj.us/treasury/revenue/eft1.htm *PLEASE INDICATE BEGINNING DATE (Required) OF NEW ACCOUNT: ___/____/_ ___ (fill in). Do not send EFT payments on or after the above date. Once you begin using checks, continue to do so unt il advised by the Division to resume EFT. Allow 15-20 working days from the beginning date (listed above) for this request to be processed. Until notified to resume the use of EFT, remit payments by check and submit the necessary paper return as usual (informal, if necessary). Do not send checks and/or returns to the EFT Unit. *Note: If EFT is used after the date indicated (above) and before notification from the Division, payments may not be properly debited and could result in penalty and interest charges being assessed. ________________________________________________________________________ ______________________ Taxpayer Name: _________________________________________ NJ Reg #: _ _ _ - _ _ - _ _ _ _ / _ _ _ ( ) Contact Name: __________________________________________ Phone: ____________________________ ( ) Address: ________________________________________________ Fax ____________________________ #: City: ___________________________________________________ State: ______ Zip: _____________________ Account Type: _____Checking _____Savings New Transit/Routing #:_______________ New Bank Acct. #_____________________ Tax Type ____________ New Transit/Routing #:_______________ New Bank Acct. #_____________________ Tax Type ____________ New Transit/Routing #:_______________ New Bank Acct. #_____________________ Tax Type ____________ New Transit/Routing #:_______________ New Bank Acct. #_____________________ Tax Type ____________ The New Jersey Division of Revenue is hereby authorized to debit entries to the bank account(s) identified above and the bank is authorized to debit such account(s). The authority is to remain in full force until EFT payments are no longer required by statute or, if I am a voluntary participant, until the New Jersey Division of Revenue and I mutually agree to terminate my participation in the EFT program. Signature:__________________________________ Title:_____________________ __________ Date:_____________
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