Hawaii Authorization for Electronic Funds Transfer

Authorization for Electronic Funds Transfer
Form EFT-1 Rev 2014 Authorization Agreement for Electronic Funds Transfer (EFT)
Clear Form
FORM

STATE OF HAWAII––DEPARTMENT OF TAXATION

EFT-1

DO NOT WRITE OR STAPLE IN THIS SPACE

AUTHORIZATION AGREEMENT FOR
ELECTRONIC FUNDS TRANSFER (EFT)

(REV. 2017)

	 Declaring EFT Method to:   ACH Debit   ACH Credit   DOTAX E-Services
	 Adding Tax Type
	 Changing bank information for ACH Debit - Complete Part I below and Part III on page 2.
		
PART I

Taxpayer Information

Taxpayer’s Name

Trade Name or Doing Business As (DBA) Name	

FEIN/SSN

	
C/O	

Contact Person

Mailing Address (Number and Street)	

Contact Person Telephone Number

	

(     )                         

City or Town, State, and Postal/ZIP Code	

Contact E-mail Address

Please indicate the tax types that you will be paying by EFT by checking the appropriate tax type box(es) below. Enter the identification number for each tax
type in the corresponding box. Note: The Department of Taxation (DOTAX) will not require an employer whose withholding liability exceeds $40,000 to pay
by EFT if such employer is not required to remit their federal employment taxes electronically.
		 Tax Type	

		General Excise and Use	
	 	Withholding	
	 	Transient Accommodations	
	 	Rental Motor Vehicle, Tour Vehicle
		

Tax Type Code	 Hawaii Tax I.D. No.

Tax Type Code	 Hawaii Tax I.D. No.

		Fuel	
	 	Liquor	
	 	Cigarette and Tobacco	
	 	Individual Income	
	 	Corporation	
	 	Fiduciary Income	
	 	Individual Estimated Income	
	 	Corporation Estimated Income	
	 	Estates and Trusts Estimated Income	

04610
01130
07420

& Car-Sharing Vehicle Surcharge	20070
15095
15077
02287
02177

		Public Service Company (PSC)	
	 	PSC Installment (FP-1)	
	 	Franchise	
	 	Franchise Installment (FP-1)	
	 Part II	

		 Tax Type	

05007
06418
07219
01311
02230
01740
01201
02103
01205

Method of EFT Payment. Check only one box to indicate your method of EFT payment.

	 Method I — Payment through the Hawaii DOTAX Electronic Services Website. DOTAX is hereby notified that the above-named taxpayer will
make payments through one of the options listed on DOTAX’s Electronic Services website at tax.hawaii.gov/eservices/.

	 Method II — ACH Debit (Payment through the telephone). Complete the bank information below. Reminder: Attach voided check.

If you have more than one Hawaii Tax Identification Number (HTIN) for a tax type you are paying by EFT, you must submit a separate Form EFT-1
for that HTIN. DOTAX is hereby authorized to present debit entries which I or my authorized agent originates to the bank 	account identified below
and the bank is authorized to debit such account for the tax(es) identified above.

	
	

Account Name

Account Number (Not to exceed 17 digits)

Bank Name

Transfer/Routing Number (Requires 9 digits)

	 Method III — ACH Credit.

DOTAX is hereby requested to grant approval for the above named taxpayer to initiate ACH Credit transactions to the State of Hawaii’s bank
account. These payments must be in the NACHA CCD+ format using the Tax Payment Convention (TXP).
If you have additional HTIN, please list: 
				

DECLARATION
The above authority is to remain in effect until EFT payments are no longer required by statute; until I am notified in writing that the State of Hawaii Department of Taxation has
withdrawn its approval for use of the ACH Credit method (if Method III is checked); or, if I am a voluntary participant, until the State of Hawaii Department of Taxation and I mutually
agree to terminate my participation in the EFT program.

	
	
Signature of Owner, Partner or Member, Fiduciary, or Officer		

	
	
Title:  Owner, Partner or Member, Fiduciary, or Officer		

	
Date

	
Print Name of Owner, Partner or Member, Fiduciary, or Officer					 FORM EFT-1

FORM EFT-1	
(REV. 2017)

Page 2

		
PART III Changing Bank Information for ACH Debit Method
Access Code __ __ __ __ __ __ __
		 
	
	

	

OLD BANK INFORMATION

Account Name

Account Number (Not to exceed 17 digits)

Bank Name

		 
	

D
	 ate bank information will be changed:

Transfer/Routing Number (Requires 9 digits)

NEW BANK INFORMATION   Reminder: Please attach voided check.

Account Name

Account Number (Not to exceed 17 digits)

Bank Name

GENERAL INSTRUCTIONS
Please make a copy of your application for
your records.
For more information, see Tax Information
Release (TIR) No. 95-06, “Questions and Answers on Paying Taxes by Electronic Funds
Transfer;” TIR No. 99-01, “Filing of Tax Returns
Required by Taxpayers Who Pay Taxes by Electronic Funds Transfer (EFT);” TIR No. 2004-01,
“Act 113, Session Laws of Hawaii 2004, Relating
to Income Tax Withholding;” and Tax Announcement 2011-04, “Additional Tax Types Required to
be Paid by Electronic Funds Transfer (EFT).”
PENALTIES. Section 231-9.9, Hawaii Revised Statutes (HRS), imposes a penalty of 2%
of the tax due if those who are required to make
payments by EFT do not do so on or before the
date prescribed without reasonable cause. This
is in addition to any other penalties. Also, section
40-35.5, HRS, allows DOTAX to assess a $25
service fee on electronic funds transfer payments
that are dishonored. This service fee cannot be
waived.

SPECIFIC INSTRUCTIONS
Part I — Taxpayer Information
Enter the identification number for the tax
type. If you have more than one Hawaii Tax Identification Number (HTIN) for a tax type you are
paying by EFT, you must submit a separate Form
EFT-1 for that HTIN. All taxpayer information
must be completed and must match the taxpayer
information on file with DOTAX.

Part II — Method of EFT Payment
Check the applicable box to indicate your
method of EFT payment.

Method I — Payment through DOTAX’s
Electronic Services Website
Check the box for Method I to notify DOTAX
that you will make your tax payments through
DOTAX’s Electronic Services website.

Method II — ACH Debit (Payment through
the telephone)
Check the box for Method II if you wish to pay
by ACH Debit (Payment through the telephone).

Transfer/Routing Number (Requires 9 digits)

Please provide your complete bank information
and attach a voided check.
If you will be paying for more than one tax
type using the same bank account and same
HTIN, complete only one Form EFT-1. You may
pay for any of the taxes listed on the form by EFT
even if you do not exceed $100,000 for that particular tax type ($40,000 for withholding taxes).
If you will be using more than one bank account or HTIN, please complete a Form EFT-1
for each account or HTIN you will be using.
The bank information can be obtained from
your bank or at the bottom of the check.
Account number should not exceed 17 digits.
Transfer/Routing Number requires 9 digits.
Omit hyphens in your bank numbers.
Please remember to attach a voided check
from the bank account you want debited.

Method III — ACH Credit
Check the box for Method III if you wish to pay
by ACH Credit.
Some financial institutions offer ACH origination services. Contact your bank to determine
what ACH origination services it offers and the
costs of ACH Credit service. You cannot use
Method III unless your bank can initiate transactions in the CCD+TXP format.
Please remember that if you use Method III,
DOTAX is not responsible for the successful
completion of EFT transactions that are required
by law. Furthermore, DOTAX will not pay any
costs your financial institution may charge you
for its services.

Part III — Changing Bank Information
for ACH Debit Method
Provide your complete bank information for
your old bank account and your new bank account. If you are changing your bank information and the effective date of change is noted on
Form EFT-1, the change will be done no earlier
than that date.
Please remember to attach a voided check
from the new bank account you want debited.

Signature
Form EFT-1 must be signed by an owner,
partner or member, fiduciary, or officer.
If you wish to use Method II, Form EFT-1 must
be signed by an owner, partner or member, fiduciary, or officer who is authorized to sign checks
drawn on the account identified on the form.

IMPORTANT INFORMATION
If you checked Method II or Method III, you
will receive a confirmation letter in the mail. The
letter will include instructions for how to make a
payment using your chosen method. No ACH
Debit or ACH Credit EFT payments should be
attempted before the confirmation letter is received.
Method II applicants will also receive their access code with the confirmation letter. The personal identification number (PIN) will be mailed
under separate cover from the data collection
center.
Method III applicants should be aware that
DOTAX may withdraw its approval for use of ACH
Credit for failure to conform to the requirements
for ACH Credit transactions.
Method I applicants will NOT be sent a confirmation letter in the mail. After submitting your
Form EFT-1 to notify us of your intent to file and
pay using our Electronic Services website, you
must register for an E-File account at tax.hawaii.
gov/eservices/. Afterwards, you will receive an
e-mailed confirmation of your registration.
You must submit a Form EFT-1 if you wish to
change from one ACH payment method to the
other. You must continue making your tax payments through EFT using the method in use until
you receive confirmation authorizing the change
and the effective date of the change.
If you have any questions, please contact
DOTAX’s Electronic Processing Section at:
E-mail: [email protected]
Telephone: 808-543-6814
Fax: 808-587-1488
Mail the completed Form EFT-1 to:
EFT Program
Hawaii Department of Taxation
P.O. Box 259
Honolulu, HI 96809-0259