Fillable Electronic Funds Transfer (EFT) Account Setup For Tax (Colorado DORA)

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Electronic Funds Transfer (EFT) Account Setup For Tax (Colorado DORA)

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The Electronic Funds Transfer (EFT) Account Setup For Tax (Colorado DORA) form is 1 page long and contains:

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  • 5 check-boxes
  • 36 other fields

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File type: PDF

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Electronic Funds Transfer (EFT)
Account Setup For Tax Payments
EFT Number
To be assigned by Department of Revenue
Taxpayer Name Contact Person
Set Up New Account
Mailing Address (Street Number, Apt. Number, Box Number) FEIN or Social Security Number
Modify Account
Telephone Number
Add Taxes
City, State, ZIP Fax Number
Remove Taxes
Email Address
Add Additional EFT Number(s)
Tax To Be Paid by EFT Transactions.
Must be completed for either ACH debit or ACH credit.
See listing of taxes and tax type codes on reverse side.
Tax Type Tax Type Code Your DOR Account
Complete Section 1 and/or 2
Section 1—ACH Debit
ACH Debit—taxpayer selects the EFT payment option on our web page or calls a toll free number
I hereby authorize the Colorado Department of Revenue (DOR), to initiate debit entries to my banking account. This
authority is to remain in full force and effect until DOR and Financial Institution have received written notication
from me of its termination in such time and in such manner as to afford DOR and FI a reasonable time to act
on it. The use of an EFT identication number and password will be required to convey my instructions for each
transaction. The EFT identication number and password may be used by me or by my agent. You will be able to
provide your banking information 24 hours after your registration for EFT.
Authorized Signature Title Date (MM/DD/YY)
Section 2—ACH Credit
ACH Credit—taxpayer initiates through own nancial institution.
I have contacted my nancial institution and conrmed the nancial institution can initiate Automated Clearing House
credit transactions that meet Colorado Department of Revenue (DOR) requirements. For verication, DOR may contact:
Name of Bank Bank Contact Person Telephone Number
I hereby request DOR grant authority for the above named taxpayer to initiate Automated Clearing House credit
transactions to DOR's bank account. I understand these must be in the NACHA CCD+ format using the Tax Payment
(TXP) Convention or the Third Party Payment (TPP) Convention. May only be initiated for the tax types that have
been registered for EFT payments with DOR.
Authorized Signature Title Date (MM/DD/YY)
Please return application to: Colorado Department of Revenue, P.O. Box 173350, Denver CO 80217-3350,
Fax: (303) 205-5779. Email: dor_afs_piercecashiers@state.co.us
DR 5785 (04/01/20)
COLORADO DEPARTMENT OF REVENUE
Pierce Cashiers Room 132
P.O. Box 173350
Denver CO 80217-3350
Addendum To Authorization Agreement For Electronic Funds Transfer (EFT) For
Tax Payments a Separate Tax Return Must be Filed For Most Tax Payments
*Do not le a tax return for these tax payments, the EFT transaction is the ling. For all other tax payments,
a tax return is required.
Tax Type Description Code
Delinquency/Bill Payment:
TPP Addenda Garnishment*
(ACH Credit only) 209
Individual Income Bill* 210
Severance Bill* 08405
Severance Withholding Bill* 01185
Wage Withholding Bill Payment* 01130
Excise:
Cigarette 072
Fuel Distributors 052
IFTA 059
IRP Registration 102
Liquor Excise 065
Marijuana Excise 180
Passenger Mile 0532
PUC Fixed Utility Fees* 204
Tobacco Products 073
Winery Direct Shipper 06510
Fees:
Prepaid Wireless E911 Surcharge 049
Vehicle Daily Rental Fee 077
Gaming/ Racing:
Dog Racing* 1421
Gaming 141
Gaming Backup Withholding* 01114
Sports Betting 151
Horse Racing* 1422
Racing Cash Fund* 1423
Racing Source Market Fee 140
Income:
Corporation 01312
Corporation Estimated* 01212
Corporation Extension* 01412
Estate/ Trust Estimated Income 01704
Fiduciary 017
Individual Income 01304
Tax Type Description Code
Individual Estimated* 01204
Individual Extension* 01404
Pass-Through Entity 01320
Pass-Through Entity Estimated* 01220
Pass-Through Entity Extension* 01420
Wage Withholding* 011
Wage Withholding Annual Reconciliation 01102
1099 Withholding* 01105
1099 Withholding Annual Reconciliation 01106
Sales:
Aviation Fuel Consumer Use 05430
Aviation Fuel Retailer’s Use 05420
Aviation Fuel Sales 054
Consumer Use - Business 045
County Lodging 074
Local Marketing District 04810
Retail Marijuana Sales 18001
Retailer’s Use 044
Sales 042
Sales Tax License Renewal* 242
Special District Sales 04202
Special Event Sales 04201
Special Event Sales License 04212
Severance:
Coal 08503
Coal Estimated* 08502
Metallic Minerals 08603
Metallic Minerals Estimated* 08602
Molybdenum 08613
Oil, Gas, & CO2 08403
Oil, Gas, & CO2 Estimated* 08402
Oil Shale 08103
Oil Shale Estimated* 08102
Severance Withholding* 01180
Severance Withholding Annual Reconciliation 01181
DR 5785 (04/01/20)
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Electronic Funds Transfer (EFT) Account Setup For Tax (Colorado DORA)

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Completed 15 July 2020

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