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FORM EFT                                                                                          COMPLETE THIS SECTION
                                                                                         Name of Business
Tax Type: Check type(s) 
                                                                                         Maryland Central Registration Number
  Withholding (MW506 only)                         Comptroller of Maryland
  Digital Advertising Gross                        Authorization Agreement for           Federal Employer Identification Number
  Revenues Tax                                     Electronic Funds Transfers
  Corporation Income Tax                                                                 Motor Fuel Tax Account Number (if applicable)
  (Pass-through Entities are not                     New
  eligible.)
                                                     Revision: Effective Date __________
  Motor Fuel Taxes                           Allow 10 business days to process.

                                                   This section must be completed by all taxpayers
  C
  O
            Primary EFT contact person                  Email 
  N
  T
  A         Street Address 
  C
  T         City                                                               State     ZIP Code        Telephone number
A
  P
            Secondary EFT contact person 
  E
  R
  S         Address 
  O
  N         City                                                               State     ZIP Code + 4    Telephone number
  (S)
            Signature of owner, partner or officer                                       Title           Date

                            CHOOSE ONLY ONE OF THE TWO PAYMENT OPTIONS BELOW

  A
  C         If ACH Debit is chosen, you authorize the Comptroller of Maryland to present the debit entries to your bank for the 
  H         tax identified above. Only you can initiate a debit by calling the State’s Service Bureau and indicating the amount of 
            tax to be paid by electronic funds transfer.
B D
  E
  B
  I         Signature of owner, partner or officer                                       Title           Date
  T

            An AUTHORIZED REPRESENTATIVE of your bank must complete and sign this section confirming that you and your bank 
  A         are capable of initiating ACH CREDITS in the required CCD + TXP format.
  C
  H
            Bank name 
C C
  R         Bank address 
  E
  D
  I         City                                                                   State ZIP Code + 4
  T
            Printed name of bank representative                                          Telephone number

            Signature of bank representative                                             Date

                         This form must be completed and faxed to 410-260-6214 or mailed to:
                    Electronic Funds Transfer Program, P.O. Box 549, Annapolis, MD 21404-549
COM/RAD-072 06/22                                                                                                                  1

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Instructions for Form EFT

Tax Type: Businesses may use electronic funds transfers (EFT) ACH CREDIT OPTION
to file and pay Maryland withholding, motor fuel, corporate
income, and digital advertising gross revenues taxes. Accepted To use the ACH Credit option, you must first contact your bank to
business forms are: 500, 500D, 500E, 600D, and 600 only. determine if your bank offers ACH Origination. Have your bank
Forms 510, 510D, and 510E for Pass-through Entities, complete the specific portion of the Authorization Agreement
and Form MW508 for Withholding are NOT accepted. (Form EFT) as verification that your bank can conform to these
standards. Also, complete Section A and Section C before
Section A – This section must be completed by ALL returning the form to the Electronic Funds Transfer Program
taxpayers. Office.
• Business name - required. Supplemental filing information must be sent with your payment
• Email - Enter the primary EFT contact person’s email using the ACH standard CCD+ format and the TXP addenda
address. record. The Cash Concentration or Disbursement (CCD) is
the most basic form of ACH payment. The CCD format can be
• Maryland Central Registration Number - if registered. processed by all ACH-member banks. The TXP addenda record
• Federal Employer Identification Number - required. allows the format to carry additional characters of payment-
related data. The TXP will be used for tax registration, tax type
• Motor Fuel Tax Account Number - if applicable. code and tax period end date.
• EFT contact person: The primary contact person should You will initiate the credit transaction through your bank to the
be someone within your company who will be directly State’s bank account for the amount of your tax payment.
involved in all phases of the EFT registration process,
system implementation, and the payment of the tax. An ACH origination charge from you bank will be incurred by you
Instructions will be mailed, or emailed if provided, to the if you select the ACH Credit option.
contact person designated on the agreement. You also Important characteristics of the ACH Credit transactions
should designate a secondary contact person. are:
• Address: Indicate the mailing address to be used for
correspondence regarding electronic funds transfer. • Credit transactions require you to enter all payment related
data in the standard CCD+ TXP.
• Telephone number: Indicate the telephone number(s)
for the EFT contact person. • The costs of the ACH Credit transactions are incurred by
you.
• Signature of owner, partner or officer: Authorized
signature of owner, partner or officer of the company. • You are responsible for your own proof of payment.
Section B – Complete this section only if you are choosing ACH DEBIT OPTION
the ACH Debit option. Note: The ACH Debit option is not
available for digital advertising gross revenues tax (DAGRT). To use the ACH Debit option, complete Section A and Section
To pay DAGRT via EFT, you must choose ACH Credit. B before returning the form to the Electronic Funds Transfer
Program Office.
• Signature of owner, partner or officer: Authorized
signature of owner, partner or officer of the company. This After we receive the Authorization Agreement, we will provide
signature will authorize the Comptroller of Maryland to you with the specific instructions on the initiation of Electronic
present debit entries. Funds Transfer. You authorize each payment amount to be
transferred from your bank account to the State’s bank by using
Section C – Complete this section only if you are choosing a toll-free number.
the ACH Credit option. ACH Credit is available for all tax
types listed on this form. After you complete the call, the Comptroller of Maryland is
responsible for the successful completion of the transaction. The
Name and address of the bank: Provide the name and State’s Service Bureau will provide you with a verification code
address of the bank you will be using for electronic funds indicating that you have completed the necessary steps for the
transfers. initiation of the Electronic Funds Transfer.
Printed name and signature of bank representative
(include bank representative’s telephone number): You cannot
use the ACH Credit option unless your bank can initiate
transactions in this format.
Mail this completed form to:
Electronic Funds Transfer Program
P.O. Box 549
Annapolis, MD 21404-549

Electronic Funds Transfer Program telephone number 410-260-7980 • Fax: 410-260-6214
Hearing impaired users call via Maryland Relay at 711 in Maryland
COM/RAD-072 06/22 2

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