instructions to enroll in electronic services
TRANSCRIPT
Taxpayer Name: Email Address:
Instructions to Enroll in Electronic Services
1. Gather The Documents You’ll Need:
Reporting Agent Authorization, federal form (attached) - Have a principal officer or partner sign the form at the bottom and write his/her title and the date.
Electronic Services Authorization, state form (attached) - Have a principal officer or partner sign the form at the bottom and write his/her title and the date.
Indiana Department of Revenue Authorization Agreement Form for Electronic Funds Transfer (attached). • Check the box next to “EFT Required or Voluntary.” Note: You are required to
participate in EFT if the state of Indiana has so notified you or if your average monthly withholding payments are $10,000 or more.
• Have a principal officer or partner sign the form at the bottom and write his/her title and the date.
Voided Check – Write “VOID” on a check from the account you wish to use for Electronic Services (E-Services).
2. Return the Documents to Us Either:
By Fax – Using the attached FAX Cover Sheet –OR- By Mail – To the address on the attached FAX Cover Sheet
3. E-Services Enrollment - What Happens Next?
Overall, you should allow at least a week for federal and state enrollment, and 3 weeks for Direct Deposit enrollment from the time we receive your signed forms.
• It takes 1-2 business days for us to receive and process your E-Services enrollment forms. • Once we’ve processed your enrollment forms, you will receive an additional email from us
with detailed instructions for completing your E-Services enrollment.
FAX
To: From:
Fax: Date:
Pages: 4 - including cover sheet
Attach the following documents to this FAX Cover Sheet and fax to the number above. [ ] Reporting Agent Authorization - signed [ ] Electronic Services Authorization – signed [ ] Indiana Department of Revenue Authorization Agreement Form for Electronic Funds Transfer -
EFT box checked and form signed [ ] Voided check – attached below If you don’t have access to a fax machine, you may mail the documents to: - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Attach Voided Check Here - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
E-Services Enrollment
2134880
OMB No. 1545-1058Reporting Agent Authorization
Department of the TreasuryInternal Revenue Service
For Privacy Act and Paperwork Reduction Act Notice, see page 2. Form 8655 (Rev. 5-2005)Cat. No. 10241T
Employer identification number (EIN)
(Rev. May 2005)
Form
Name of taxpayer (as distinguished from trade name)1a
8655
Address (number, street, and room or suite no.)
City or town, state, and ZIP code
Contact person
1b
Fax number8
I certify I have the authority to execute this form and authorize disclosure of otherwise confidential information on behalf of the taxpayer.
Signature of taxpayer Date
SignHere
� �
Taxpayer
5
2
4 If you are a seasonal employer,check here
Other identification number
7 Daytime telephone number
( )
Name (enter company name or name of business)9
Address (number, street, and room or suite no.)
City or town, state, and ZIP code
Contact person12 14
Reporting Agent10
13 Daytime telephone number
( )
11
Title�
Authorization of Reporting Agent To Sign and File ReturnsUse the entry lines below to indicate the tax return(s) to be filed by the reporting agent. Enter the beginning year of annual tax returns orbeginning quarter of quarterly tax returns. See the instructions for how to enter the quarter and year. Once this authority is granted, it iseffective until revoked by the taxpayer or reporting agent.
940 941
Authorization of Reporting Agent To Make Deposits and PaymentsUse the entry lines below to enter the starting date (the first month and year) of any tax return(s) for which the reporting agent is authorized tomake deposits or payments. See the instructions for how to enter the month and year. Once this authority is granted, it is effective until revokedby the taxpayer or reporting agent.
940 941 943 945 720 1041
1042 1120 CT-1 990-C 990-PF 990-T
Disclosure of Information to Reporting Agents
Check here to authorize the reporting agent to receive or request copies of tax information and other communications from the IRS relatedto the authorization granted on line 15 and/or line 16
Authorization AgreementI understand that this agreement does not relieve me, as the taxpayer, of the responsibility to ensure that all tax returns are filed and that all deposits and payments are made. If line15 is completed, the reporting agent named above is authorized to sign and file the return indicated, beginning with the quarter or year indicated. If any starting dates on line 16 are completed,the reporting agent named above is authorized to make deposits and payments beginning with the period indicated. Any authorization granted remains in effect until it is revoked by the taxpayeror reporting agent. I am authorizing the IRS to disclose otherwise confidential tax information to the reporting agent relating to the authority granted on line 15 and/or line 16, including disclosuresrequired to process Form 8655. Disclosure authority is effective upon signature of taxpayer and IRS receipt of Form 8655. The authority granted on Form 8655 will not revoke any Power of Attorney(Form 2848) or Tax Information Authorization (Form 8821) in effect.
15
16
17a
940-PR 941-PR 941-SS 943
943-PR 945 1042 CT-1
Trade name, if any
3
State or Local AuthorizationCheck here to authorize the reporting agent to sign and file state or local returns related to the authorization granted on line 15 and/or line 16
19
( )
Employer identification number (EIN)
6
Fax number
( )
944
944
Form W-2 series or Form 1099 series Disclosure Authorization
The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRSnotices relating to the Form W-2 series information returns. This authority is effective for calendar year forms beginning .
18a
The reporting agent is authorized to receive otherwise confidential taxpayer information from the IRS to assist in responding to certain IRSnotices relating to the Form 1099 series information returns. This authority is effective for calendar year forms beginning .
b
944-PR
Check here if the reporting agent also wants to receive copies of notices from the IRSb
Form 8655 (Rev. 5-2005) Page 2 IRS Privacy Act and Paperwork Reduction Act Notice We ask for the information on this form to carry out the Internal Revenue laws of the United States. Form 8655 is provided by the IRS for your convenience and its use is voluntary. If you choose to authorize a reporting agent to act on your behalf, under section 6109, you must disclose your EIN. The principal purpose of this disclosure is to secure proper identification of the taxpayer. We need this information to gain access to your tax information in our files and properly respond to your request. If you do not disclose this information, the IRS may suspend processing your reporting agent authorization and may not be able to honor your reporting agent authorization until you provide your EIN.
Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation, and to cities, states, and the District of Columbia for use in administering their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement agencies and intelligence agencies to combat terrorism. You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. The time needed to complete and file Form 8655 will vary depending on individual circumstances. The estimated average time is 6 minutes. If you have comments concerning the accuracy of this time estimate or suggestions for making Form 8655 simpler, we would be happy to hear from you. You can write to the Internal Revenue Service, Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, IR-6406, Washington, DC 20224. Do not send Form 8655 to this address.
Electronic Services Authorization and Power of Attorney (In Accordance with Indiana Power of Attorney POA-1) Federal Employer ID No.: IN Taxpayer ID Number: Taxpayer Name: Telephone Number:
Taxpayer DBA Name:
Address:
EFT Contact Person: Title:
Email Address: Telephone Number:
Reporting Agent Name: FAX Number:
Reporting Agent Address:
Federal ID Number:
Checking Account No.: Routing Transit Number:
Indiana Department of Revenue Power of Attorney: On behalf of the taxpayer, I hereby appointed the designated agent identified above as attorney-in-fact to represent the taxpayer in all matters relating to electronic payment of Indiana withholding tax, including without limitation initiation of electronic payments to the State of Indiana. Indiana Electronic Services: I understand that this authorization does not relieve me, as the taxpayer, of the responsibility to ensure that all tax returns are filed and all deposits and payments are made on time. PayCycle, Inc. (“Agent”) is authorized to enroll the above taxpayer in State of Indiana electronic services, and/or to make State of Indiana tax deposits and other State of Indiana tax payments for the above taxpayer. This Authorization applies as of the date this Authorization is signed and remains in effect until the taxpayer or Agent notifies the State of Indiana that this authorization is terminated or revoked. I authorize the State of Indiana to disclose to Agent otherwise confidential tax information relating to employment tax returns to be filed by Agent and/or relating to payments to be made by Agent (including deposit requirements). I certify that I have the authority to authorize the disclosure of otherwise confidential tax information on behalf of the taxpayer. Direct Deposit: Agent is hereby authorized to initiate debit entries to my checking account identified above and to debit the same to that account. I acknowledge that Agent will withdraw funds, in the amounts specified using Agent’s paycheck approval process, and transfer them to my designated employee accounts for the purpose of paying my employees. In the event of an error, I hereby authorize Agent to credit such account to offset the error. Agent Authorization: Agent is hereby authorized to initiate debit entries to my checking account identified above and to debit the same account in order to withdraw funds in the amounts specified using Agent’s tax payment approval process and transfer them to the Indiana Department of Revenue (or any successor to such agency) to pay my State of Indiana withholding taxes. In the event of an error, I hereby authorize Agent to credit the account to offset the error. I further authorize Agent to instruct the IRS to withdraw funds from the checking account identified above in the amounts specified using Agent’s tax payment approval process to pay my federal payroll taxes. Finally, I agree that approval of all federal and State of Indiana filings on the Agent website will constitute my electronic signature declaring, under penalties of perjury, that I have examined each return (including any accompanying schedules and statements) and to the best of my knowledge and belief each is a true, correct and complete return. I further authorize Agent to release a copy of this Electronic Services Authorization and Power of Attorney to the Indiana Department of Revenue. All of the foregoing authorizations will remain in full force until Agent or I terminate electronic services. Company Name:
Email Address:
Signature:
Title:
Date:
Jay-Crew Landscape, Inc
2134880
Agent is hereby authorized to make an offsetting debit and credit of up to $1.00 to the checking account identified above, at the bank identified above, for verification purposes.
-
INDIANA DEPARTMENT OF REVENUEAUTHORIZATION AGREEMENT FORM
FOR ELECTRONIC FUNDS TRANSFER
INDIANA TAXPAYER ID #: ________________________________(MUST BE 13 DIGITS) See Special Instructions on Back.
Business Name:
Name and Telephone Number of Individual in your Organization that Revenue may contact regarding EFT:
Contact Person:(Not a Bank contact) (Please print)
Address:
City, State, Zip:
Telephone:
FOR TAX TYPE:Please complete a separate form for each Tax Type selected
Sales (RST) Special Fuel Suppliers (SFT)
Withholding (WTH) Special Fuel Permissive Suppliers (SFT)
Prepaid Sales on Gasoline (PPD) Gasoline Distributors (MFT)
Corporate Income (COR) Financial Institution (FIT)
Utility Receipts Tax (URT)
Please choose an EFT method. If you choose ACH Debit, you must also complete the banking information portion of this form, as well as attach a copyof a voided check to verify the banking information.
ACH Debit* (Complete bank information) Checking or Savings
ACH Credit Bank ABA#: _________________________________(Transit Routing Number)
Your Account #: ______________________________(With the above bank)
________________________________________________ ______________________ __________________Authorized Signature Title Date
*If ACH Debit is chosen, the taxpayer hereby authorizes the Indiana Department of Revenue to present debit entries into thebank account referenced above as required by Indiana Law. These debits will pertain only to Electronic Funds Transferpayments that the taxpayer has initiated.
EFT-1State Form 50110(R1 / 10-02)
DATE:
EFT Requiredor
Voluntary