Form Dr 5785 – Fill Out and Use This PDF

Complete Section 1 and/or 2

Section 1—ACH Debit

ACH Debit—taxpayer selects the EFT payment option on our web page or calls a toll free number

I hereby authorize the Colorado Department of Revenue (DOR), to initiate debit entries to my banking account. This authority is to remain in full force and effect until DOR and Financial Institution have received written notiication

from me of its termination in such time and in such manner as to afford DOR and FI a reasonable time to act on it. The use of an EFT identiication number and password will be required to convey my instructions for each transaction. The EFT identiication number and password may be used by me or by my agent. You will be able to

provide your banking information 24 hours after your registration for EFT.

Section 2—ACH Credit

ACH Credit—taxpayer initiates through own inancial institution.

I have contacted my inancial institution and conirmed the inancial institution can initiate Automated Clearing House credit transactions that meet Colorado Department of Revenue (DOR) requirements. For veriication, DOR

may contact:

I hereby request DOR grant authority for the above named taxpayer to initiate Automated Clearing House credit

transactions to DOR's bank account. I understand these must be in the NACHA CCD+ format using the Tax Payment (TXP) Convention and may only be initiated for the tax types that have been registered for EFT payments with DOR.

Please return application to: Colorado Department of Revenue, CDO Research, 1375 Sherman Street, Denver CO 80261

or fax to (303) 866-3112.

Addendum To Authorization Agreement For Electronic Funds Transfer (EFT) For Tax Payments a Separate Tax Return Must be Filed For Most Tax Payments

*Do not ile a tax return for these tax payments, the EFT transaction is the iling. For all other tax payments,

a tax return is required.