This form is included with Pub 43

                                                                                       Print Form                Clear form
                                                         Utah State Tax Commission
                                      210 North 1950 West • Salt Lake City, UT 84134 • www.tax.utah.gov              TC-86
                 Registration to Make Utah Tax Payments Through EFT ACH Credit                                       Rev. 11/16

     Taxpayers who make Utah tax payments using EFT ACH Credit must follow the terms and conditions set forth below. 
     Complete and sign this application, and submit it to the Tax Commission at the address below.

Company Identification
Company name                                                                 Utah 14-digit tax account number        Tax Type Code
                                                                             (list each separately)*                          (see below)
Address                                                                                                               

City                                               State     ZIP Code

Telephone number            Fax number                       Federal EIN

Email address 

Contact person within the company           Contact person’s title

    *If you do not know your 14-digit account number, enter your EIN.
Company Authorization and Agreement
 The above taxpayer will initiate tax payments to the Utah State Tax Commission using electronic funds transfer through the ACH 
 Credit method. Funds will be electronically remitted from the taxpayer’s bank account to the Tax Commission’s bank account.
 The Taxpayer will follow all procedures for each tax type and will conform to the addendum transfer format and content detailed 
 in Pub. 43, Electronic Funds Transfer. All Utah tax laws and rules will remain in effect.
 By signing this registration I confirm all the information is correct and I will follow the addendum format and content 
 in Pub 43.
                            Authorized signature

                            Title                                                   Date
                                                                                                                 Print Form
 
To Request EFT Authorization...
  •  Fill out, sign and mail this form to the address below, or fax to 801-297-7698

                 Electronic Funds Transfer Unit
                 Utah State Tax Commission
                 210 North 1950 West
                 Salt Lake City, UT  84134

        Tax Type Codes
        Tax Type                                      Tax Type Code     Tax Type                                 Tax Type Code
        Beer                                                            Other Taxes Continued
        Beer Tax                                         0630           Sexually explicit business tax           0405
        Corporate/Partnership                                           Waste Tire Recycling Fee                 0405
        Corporate/Partnership Tax                        0220           Emergency Services Telephone Fee         0407
                                                                        Municipal Telecommunications License Tax 0408
        Fuel                                                            Radioactive Waste Tax                    0900
        Fuel Tax                                         0500           Brine Shrimp Tax                         2000
        Insurance                                                       Sales
        Insurance Premium Tax                            0710           Sales and Use Tax                        0400
        Self Insurance Tax                               0715           Transient Room Tax                       0401
        Oil, Gas, Severance                                             Motor Vehicle Rental Tax                 0403
        Oil & Gas Severance Tax (Prepayments)            0840           Restaurant Tax                           0404
        Oil & Gas Severance Tax (Payment with Return)    0841           Municipal Energy Sales and Use Tax       0406
        Oil & Gas Conservation Tax                       0803           Tobacco
        Mining Severance Tax  (Prepayments)              0880           Cigarette Stamps                         0720
        Mining Severance Tax (Payment with Return)       0881           Tobacco Products Tax                     0730
        Other Taxes                                                     Wittholding
        Lubricating oil fee                              0405           Withholding                              0110
        Multichannel audio/visual tax                    0405           Mineral Production Withholding           0800
        Prepaid disposable cell phone fee                0405

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