Centerville, OH · Gallia County
Authorization Form for Electronic Funds Transfer
Centerville employers use this authorization form to enroll in the city’s ACH Credit Electronic Filing Program for employee withholding tax payments.
What this form is
This form registers a taxpayer for Centerville’s ACH Credit Electronic Filing Program to remit employee withholding tax payments electronically. The city asks participants to complete and return it to enroll. It requests taxpayer account and federal tax ID information, financial institution details, contact information, and a taxpayer signature, date, printed name, and title.
Who needs it
Taxpayers seeking to use Centerville’s ACH Credit Electronic Filing Program for employee withholding tax payments should complete this form.
How to submit it
Mail the completed form to ACH Credit Electronic Filing Program, City of Centerville – Income Tax, 100 West Spring Valley Rd., Centerville, OH 45458.
About notarization
This document is signed without a notary; the taxpayer signs and dates the authorization on the form.
How to submit this form
- 1
Download The Form
Download the ACH Credit Electronic Filing Program authorization form.
- 2
Complete The Form
Enter the taxpayer, financial institution, and contact information requested.
- 3
Sign And Date
The taxpayer signs and dates the authorization and provides the printed name and title.
- 4
Mail To The City
Mail the completed form to the City of Centerville Income Tax Division at the address printed on the form.
Frequently asked questions
- What is the ACH electronic funds transfer authorization for?
- It enrolls a taxpayer in Centerville’s ACH Credit Electronic Filing Program for remitting employee withholding tax payments electronically.
- Who completes this authorization form?
- A taxpayer seeking to register for the program completes the form with account, financial institution, and contact information, then signs and dates it.
- Do I need a notary for the ACH authorization form?
- No. This document is signed without a notary; the taxpayer signs and dates the authorization on the form.
- How do I submit the ACH authorization form?
- Mail the completed form to ACH Credit Electronic Filing Program, City of Centerville – Income Tax, 100 West Spring Valley Rd., Centerville, OH 45458.