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           Illinois Department of Revenue 

           EFT‑1  Authorization Agreement for Certain Electronic Payments

Read this information first: Complete this form ONLY if you 1) want to pay amounts owed to the Illinois Department of 
Revenue using pay-by-phone debit or cigarette tax stamp purchase debit; or 2) are changing previously submitted information 
about one of the methods of payment listed above. 
Note: For most taxes, electronic payments can be made easily using MyTax Illinois available at mytax.illinois.gov. Do not 
complete Form EFT-1 if you pay using MyTax Illinois.

Step 1: Complete the following information

     1 Check the payment method you wish to use.                            2  If amending a previously submitted Form EFT-1 
          Pay-by-phone debit                                                a  Write the effective date of the change        ____/____/________  
        Cigarette tax stamp purchase                                        b  Reason for amending: _________________________________ 
                                                                              _________________________________________________

Step 2:  Identify yourself  
   5 _________________________________________________                      7  ___ ___  ‑  ___  ___  ___  ___  ___  ___  ___
      Taxpayer’s name                                                          Federal employer identification number (FEIN) 
   6 _________________________________________________                      8  ___  ___  ___  ‑  ___  ___  ‑  ___  ___  ___  ___
      Address                                                                   Social Security number (SSN)
    _________________________________________________  
      City                                      State        ZIP 

Step 3:  Complete designated agent or contact person information

 9  _________________________________________________                       11  (_____)_________________   (_____)__________________ 
    Designated agent’s or contact person’s name                                 Telephone                           Fax
10     _________________________________________________                    12  _________________________________________________ 
       Address                                                                  Email address        

   _________________________________________________                        13  _________________________________________________ 
   City                                         State        ZIP               Signature authorization (authorized officer of designated agent or contact person)

Step 4: Check the taxes for which you wish to authorize these payments
Illinois income taxes:                                                      Excise taxes:
       Individual Income Tax                    _____________________             Cigarette Tax Stamp Purchase                 _____________________ 
                                                Illinois Account ID number                                                     Illinois Account ID number  
       Withholding Income Tax                   _____________________             Electricity Dist. and Inv Cap Tax            _____________________
                                                Illinois Account ID number                                                      Illinois Account ID number 
       Business Income Tax                      _____________________             Electricity Excise Tax                       _____________________
                                                Illinois Account ID number                                                      Illinois Account ID number  
 Sales taxes:                                                                     Gas Revenue/Gas Use Tax                      _____________________
                                                                                                                                Illinois Account ID number  
       Sales/Use Tax & E911 Surcharge           _____________________             Hotel Operators Occupation Tax                _____________________
                                                Illinois Account ID number                                                      Illinois Account ID number  
       Chicago Soft Drink Tax                   _____________________             Liquor Tax - Airline                          _____________________
                                                Illinois Account ID number                                                      Illinois Account ID number  
       County Motor Fuel Tax                    _____________________             Liquor Tax - Importer/MFTR/Dist               _____________________
                                                Illinois Account ID number                                                      Illinois Account ID number  
       MPEA Food and Beverage Tax               _____________________             Liquor Tax - Direct Wine Shipper            _____________________ 
                                                Illinois Account ID number                                                    Illinois Account ID number 
       Prepaid Sales Tax (motor fuel)           _____________________             Telecommunications Excise Tax                 _____________________
                                                Illinois Account ID number                                                    Illinois Account ID number 
       Automobile Renting Tax                   _____________________             Telecom Infrastruct. Maint Fee              _____________________
                                                Illinois Account ID number                                                    Illinois Account ID number 
                                                                                  Tobacco Products Tax                       _____________________
                                                                                  (not for Cigarette Tax Stamps)              Illinois Account ID number 

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 Taxpayer’s name 
_________________________________________________ 

Step     5:  If using the pay‑by‑phone debit method, complete the following 
  14 _________________________________________________                        17 Check one:             Business    or                                              Individual/Consumer
    Financial institution’s name

  15 _________________________________________________                        18  Check one:            Checking    or                                              Savings
    Name on account  
  16 _________________________________________________                        19 ___  ___  ___   ___  ___   ___  ___  ___  ___
    Account number                                                               Routing transit number

Step 6: Sign and complete 
The signature of the taxpayer, authorized officer, or partner is required, as well as the title and date (even if you are using a designated agent).
For a debit payment method, I agree and understand that I am authorizing the Illinois Department of Revenue (IDOR) to make withdrawals 
from the financial institution account listed in Step 5 when payments are scheduled. 
Under penalties of perjury, I state that I have examined this form and to the best of my knowledge it is true, correct, and complete. The Illinois 
Department of Revenue is authorized to use this information in accordance with the Department of Revenue Law of the Civil Administrative 
Code of Illinois and all applicable Illinois tax acts. This agreement shall remain in force until the Department receives written notification from 
the taxpayer.
    _________________________________________________                         _______________________                                                         ____/____/________
    Signature of taxpayer, authorized officer, or partner                       Title                                                                         Date

                                                          Form EFT‑1 Instructions

                   General Information 
What payment methods require that I complete 
Form EFT‑1?                                                                   What if I need help?
Certain ACH Debits - This is an electronic payment that occurs                If you encounter any problems or have any questions regarding 
when you authorize IDOR or our agent to transfer funds from your              ACH payments, please contact the Electronic Payments Section at 
account.                                                                      217 782‑6257 or REV.taxpay@illinois.gov.
    • Pay-by-phone debit method: This option is available
                                                                                             Specific Instructions 
      for most tax accounts. You must complete a separate
      Form EFT-1 for each account from which you will make                    Step 1:  Complete the following information
      payments.                                                               Check the payment method you wish to use and whether this is an 
    •    Cigarette tax stamp purchasers: You are required to use              initial registration or if you are changing information you previously 
         the debit payment method for your cigarette tax stamp                provided. Attach additional sheets if necessary.
         orders. You must complete Form EFT-1 for the account
         from which you will make payments.                                   Step 3:  Complete designated agent or contact 
                                                                              person information
IMPORTANT: Do not complete Form EFT‑1 to make the                             If a designated agent will be transferring payments, complete Step 3. 
following electronic payments: 1) debit using MyTax Illinois at               If the designated agent is completing Form EFT-1 on behalf of a 
tax.illinois.gov; 2) direct file debit; or 3) credit card option for Illinois taxpayer, the taxpayer must provide a signature in Step 6, unless a 
Individual Income Tax (follow the instructions at tax.illinois.gov and        signed Form IL-2848-E is kept in the designated agent’s books and 
please note a convenience fee will be assessed for each credit                records.
card transaction).
                                                                              Note: If the pay-by-phone option will be used and the bank account 
Where do I send my completed Form EFT‑1?                                        is the designated agent’s, an authorized officer of the agent  
                                                                                must sign on Step 3, Line 13, to authorize us to debit that account.
Mail to:         ELECTRONIC PAYMENTS SECTION
                 ILLINOIS DEPARTMENT OF REVENUE                               The contact person should be the person who will be initiating and 
                 PO BOX 19015                                                 making the payment transfer. Include the telephone number, fax 
                 SPRINGFIELD IL  62794‑9015                                   number, and email address. 
Fax number:      217 524‑8282

                     This form is authorized as outlined under the tax or fee Act related to the tax or fee for which this form is filed.  Disclosure of this 
                     information is required.  Failure to provide information may result in this form not being processed and may result in a penalty.
Page 2 of 2                                                                           Printed by authority of the state of Illinois  - Web only, One copy EFT-1 (R-02/23)
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