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Clear form ACH Credit Agreement and Application for Combined Payroll Tax and Assessment Department of Revenue use only Date received New or Change Check the correct box to indicate whether this is

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How to fill out ach credit agreement and

01

Read the instructions provided with the ach credit agreement form

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Fill out your personal information accurately in the designated fields

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Provide your bank account details, including your account number and routing number

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Include the amount of money you intend to credit to your account

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Sign and date the agreement

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Submit the completed ach credit agreement to the relevant party

Who needs ach credit agreement and?

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Individuals who receive direct deposits

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Businesses that regularly credit funds to their own or others' bank accounts

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Financial institutions and banks

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Creditors or lenders who disburse funds electronically

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Anyone who wishes to initiate automatic credits to a bank account

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