Reset Form
Michigan Department of Treasury
4515 (Rev. 02-15)
Electronic Funds Transfer (EFT) - Account Update
This form is intended for accounts currently registered for EFT debit filing.  Complete the requested information if you choose to add or delete a tax to be paid using EFT.
PART 1: ACCOUNT INFORMATION
Company Name                                                          User ID Code (5 or 6 digits)

                                                                      Taxpayer Identification Number

Address                                                               E-Mail Address

City                                              State               ZIP Code                                  Contact Person Telephone Number

Contact Person                                                                                                  Contact Person Fax Number

PART 2: TAX INFORMATION
Check the appropriate box to add or delete a tax to be remitted by EFT debit (check all that apply).  
ADD     DELETE                                                                ADD                         DELETE
                 Single Business Tax Annual (02671)                                                       Flow Through Withholding Annual (02675)
                 Michigan Business Tax Extension (02355)                                                  Motor Fuel (05000)
                 Michigan Business Tax Annual (02655)                                                     IFTA (05900)
                 Corporate Income Tax Annual (02670)                                                      Tobacco Products Tax (07300)
                 Corporate Income Tax Estimate (02170)                                                    Tobacco Products Proposed Adjustments (07311)
                 Corporate Income Tax Extensions (02370)                                                  Tobacco License Fee/Equity Assessment (07321)
                 Flow Through Withholding Corporate Quarterly (02010)                                     Tobacco Stamp Fee (07331)
                 Flow Through Withholding Individual Quarterly (02020)
Date you wish to begin making EFT debit payments for the tax type(s) checked above. Treasury will try to complete processing by the date provided.

PART 3: AUTHORIZATION (FOR EFT DEBIT FILERS ONLY)
If you are interested in making EFT debit payments for the taxes selected above, you must give written permission to access the bank account you 
have designated to withdraw your authorized funds.  You may do this by providing your signature below.
I authorize the State of Michigan and its authorized contractor to make variable withdrawals by electronic transfer from the designated financial institution and account.  
I understand that only the withdrawals I authorize will be made and that this process is protected by a password and a user code. I understand that I may cancel this 
authorization at any time by sending a written notice to the address noted below. I agree to comply with the National Automated Clearing House Association Rules and 
Regulations about electronic transfers as they exist on the date of my signature on this form or as subsequently adopted, amended, or repealed. Michigan law governs 
electronic funds transactions authorized by this agreement in all respects except as otherwise superseded by federal law. If multiple signers are required to authorize a 
withdrawal of funds, all must sign this form. 
Signature of Responsible Officer                                      Title                                           Date

PART 4: CERTIFICATION
Complete this section if you are not currently registered to pay sales tax, use tax, or withholding tax by EFT, and have checked the box in Section 2 to 
begin remitting one or more of these taxes by EFT.
Please be aware of officer, member or partner liability as provided in Michigan Compiled Laws 205.27a(5):
“If a corporation, limited liability company, limited liability partnership, partnership, or limited partnership liable for taxes administered under this 
act fails for any reason to file the required returns or pay the tax due, any of its officers, members, managers, or partners who the department 
determines, based on either an audit or an investigation, have control or supervision of, or responsibility for, making the returns or payments is 
personally liable for the failure.......”
Signature of Corporate Officer, Partner, or Member responsible for reporting and/or paying Michigan taxes             Date

Type or Print Name                                                    Title

If you have any questions, contact the Michigan Department of Treasury at (517) 636-6925. You may fax this form to (517) 636-4520, or mail to:
                                                    Michigan Department of Treasury
                                                         Registration Unit
                                                         PO Box 30778
                                                         Lansing MI 48909-8728