9787 Tax Form 9787 with Instructions; Business Confirmation/U

Please keep this form for future reference.

BUSINESS Confirmation/Update Form –

Tax Form 9787 with Instructions (OMB 1545-1467)
Department of the Treasury

➪

Please retain this form for your records. If changes
or corrections are needed, please complete and
mail to:
EFTPS Enrollment Processing Center
P.O. Box 173788
Denver, Colorado 80217-3788

Use this form to review or modify enrollment information for the
Electronic Federal Tax Payment System (EFTPS). Critical errors and
messages are defined in the accompanying enrollment cover letter.
If this cover letter indicates you have critical errors that make it
impossible to complete your enrollment, it is necessary to return this
form with the corrections/modification made on the right side. Also,
please return this form if you wish to correct non-critical errors, or
update information on the file. If information is correct do not return
this form, but keep it for future reference.

REMEMBER – Both EFTPS payment methods are interchangeable:
• EFTPS online (www.eftps.gov)
• EFTPS by phone
For questions regarding EFTPS or this Form please call:

Do not return this form unless you have changes to your information.

EFTPS Customer Service

1-800-555-4477

en español
1-800-244-4829
For TDD (hearing impaired) support 1-800-733-4829

(24 hours a day, 7 days a week)
(24 hours a day, 7 days a week)
(8 a.m. to 8 p.m. Eastern Time)

INSTRUCTIONS: All the information that EFTPS currently has on file about paying your taxes electronically is imprinted on the left side of this form. Problems or critical errors are defined in the
accompanying cover letter. The right side is to be used to update or correct information relating to the problems or errors or any changes you wish to make to the current information. Solid areas on
the right side, indicate information that cannot be modified by this form. When completing this form, please print using all capital letters in blue or black ink.

Taxpayer Information
1. Employer Identification Number
(EIN). Your EIN can be filled in on this
form only if the original EIN you supplied
was rejected. Once an EIN has been
established by EFTPS, it can only be
changed through direct communication
with the IRS.

Please see cover letter
for necessary corrections.

Please print any updates/corrections in this space
Solid areas indicate information that cannot be modified by this form

1. Employer Identification Number (EIN):

1. CORRECTED Employer Identification Number (EIN):

2. Business Taxpayer Name:

2. CORRECTED Business Taxpayer Name:

2. Business Taxpayer Name. Your
taxpayer name as it appears on your
tax return and IRS document (for Sole
Proprietors, use the owner's name rather
than the DBA name) can be filled in on
this form only if the original EIN you
supplied was rejected. Once a taxpayer
name has been accepted by EFTPS, it
can only be changed through direct
communication with the IRS.

3. Business Street Address:

3-5. Business Address. You may not
update the business address, city, state,
Zip Code, and province, country and
postal code information. The business
address can only be changed through
direct communication with the IRS.
Form 8822 will automatically update
the address on your EFTPS enrollment.

Contact Information

Please print any updates/corrections in this space

6. Primary Contact Name:

6. NEW Primary Contact Name:

7. Primary Contact Mailing Street Address:

7. NEW Primary Contact Mailing Street Address:

8. City, State, and ZIP Code:

8. NEW City, State, and ZIP Code:

9. International: Province, Country, and Postal Code:

9. NEW Province, Country, and Postal Code:

10. Primary Contact Phone Number:

10. NEW Primary Contact Phone Number:
US
International

6. Primary Contact Name. Please fill in
the name of the new contact to whom
future confirmations will be sent.
7-9. Primary Contact Address. Please
fill in any associated updates to the street
address, city, state, zip code, and
province, country, and postal codes for
the primary contact.

PLEASE CALL THE IRS AT
4. City, State and ZIP Code:

5. Province, Country, and Postal Code:

10. Primary Contact Phone. Please fill in
any associated updates to the primary
contact phone number.
11. E-mail Address. (optional)

1-800-829-4933
OR PREPARE IRS FORM 8822 TO MAKE
CHANGES TO YOUR ADDRESS

/

-

area code
11. E-mail Address:

011-

country

city

number

11. NEW E-mail Address:

(over)

(continued)

Payment Information
12. Payment Method. This information
was gathered on your original enrollment
form. If you enrolled in EFTPS through a
financial institution, to change payment
method, you must complete a new
enrollment form.

12. Payment Method:

IF YOU ENROLLED IN EFTPS THROUGH A FINANCIAL INSTITUTION, TO
CHANGE PAYMENT METHOD YOU MUST RE-ENROLL. PLEASE CALL EFTPS
CUSTOMER SERVICE FOR FORM 9779 OR GO TO WWW.EFTPS.GOV

13-22. Optional Tax Form Payment
Amount Limits (for EFTPS Internet or
phone only). You may use this form to
identify any additional Federal tax types
that you plan to pay electronically. For
each existing or new tax type indicated,
you may wish to update a threshold
amount which will warn you if you
exceed this amount when you initiate a
tax payment through EFTPS.

Tax Form Payment Amount Limits (using EFTPS on the Internet or by phone.)

NOTE: Only alpha and numeric
characters appear in the tax forms. All
other characters are stripped from
these fields.
23-27. Financial Institution Information.
You may use this portion of the form to
correct errors or change a bank and/or
bank account from which you can initiate
electronic tax payments.

NOTE: You may also change your
Financial Institution Information using
EFTPS on the Internet or by phone.
CAUTION: You may find it prudent to
delete a RTN/account combination from
EFTPS only after you have previously
added a new RTN/account combination
to take its place, and you have
received confirmation from EFTPS that
the new bank has been successfully
accepted.
28. You may choose to have EFTPS verify
your bank account information with your
financial institution. This process takes
about 10 days. Check YES to have your
account information verified. Check NO if
you would like to use EFTPS more quickly and elect not to verify your bank
account information with your financial
institution. Once you receive your new
PIN, you may use EFTPS immediately. If
#28 is left blank, your bank account information will be verified.

NOTE: You are responsible for the
accuracy of the bank account information. If the information is incorrect,
your financial institution may return
your payments and you may incur an
IRS penalty.
29. Authorization. This section authorizes
a Financial Agent of the U.S. Treasury to
initiate tax payments from the accounts
you designate if you have requested
EFTPS on the Internet or by phone as a
payment method.

Tax Form and Threshold Amount

18.

18.

14.

14.

19.

19.

15.

15.

20.

20.

16.

16.

21.

21.

17.

17.

22.

22.

Financial Institution Information

Please print any updates/corrections in this space

23. RTN:

23. NEW RTN:

24. Account Number:

24. NEW Account Number:

25. Type:

25. NEW Type:
Checking

26. State:

26. NEW State:

27. ZIP Code:

27. NEW ZIP Code:
28.

Authorization

Savings

YES, I elect to have my bank account information verified
with my financial institution.
NO, I elect not to have my bank account information verified
with my financial institution.

29. For all payment methods: Please read the following Authorization Agreement:
I (as defined as the taxpayer whose signature is below) hereby authorize the contact person (listed in item 6 of this form) and the financial institution(s) involved
in the processing of my Electronic Federal Tax Payment System (EFTPS) payments to receive confidential information necessary to effect enrollment in EFTPS,
electronic payment of taxes, and answer inquiries and resolve issues related to enrollment and payments. This information includes, but is not limited to, passwords,
payment instructions, taxpayer name and identifying number, and payment transaction details. If signed by a corporate officer, partner, or fiduciary on behalf of
the taxpayer, I certify that I have the authority to execute this authorization on behalf of the taxpayer. This authorization is to remain in full force and effect until
the designated Financial Agents of the U.S. Treasury have received notification from me of termination in such time and in such manner to afford a reasonable
opportunity to act on it.
Only EFTPS on the Internet or by phone: Please read the following Authorization Agreement:
By completing the information in boxes 23-28 and signing below, I hereby authorize designated Financial Agents of the U.S. Treasury to initiate EFTPS debit
entries to the financial institution account indicated above, for payment of Federal taxes owed to the IRS upon request by taxpayer or his/her representative, using
the Electronic Federal Tax Payment System (EFTPS). I further authorize the financial institution named above to debit such entries to the financial institution
account indicated above. All debits initiated by the U.S. Treasury designated Financial Agents pursuant to this authorization shall be made under U.S. Treasury
regulations. This authorization is to remain in full force and effect until the designated Financial Agents of the U.S. Treasury have received written notification
from me of termination in such time and in such manner as to afford a reasonable opportunity to act on it.

NOTE: if no changes are made, there is
no need to return this form.

Print Name

U.S. Government Printing Office:
Cat. No.: 21824U

New Threshold Amount
(updates or corrections)

13.

30. Taxpayer Signature

If signed by a corporate officer, partner,
or fiduciary on behalf of the taxpayer, the
signer certifies that they have authority
to execute this authorization on behalf of
the taxpayer.

Tax Form and Threshold Amount

13.

30. Taxpayer Signature. Regardless of
the changes made on this Confirmation/
Update form, the taxpayer must sign
this section to authorize participation in
EFTPS and must return it to EFTPS.

This section also provides authorization
to share the information provided with
your financial institution(s), required for
EFTPS processing.

New Threshold Amount
(updates or corrections)

Date
Taxpayer Signature

Title
Paperwork Reduction Act Notice: In accordance with the Paperwork Reduction Act of 1995, we ask for the information in the Electronic Federal Tax Payment System (EFTPS) Enrollment Form in order to carry out the requirements of 26 United
States Code 6001, 6011, and 6109. You are not required to provide information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its
instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103. This information is
used by the Internal Revenue Service to assure that payment(s) are properly credited to the appropriate account(s). Your response is mandatory if you are required by regulations to use Electronic Funds Transfer to make your Federal Tax Deposits.
The time needed to provide this information will vary depending on individual circumstances. The estimated average time is ten minutes. If you have comments concerning the accuracy of this time estimate or suggestions for reducing this
burden, we would be happy to hear from you. You can write to the IRS Tax Products Coordinating Committee, SE:W:CAR:MP:T:T:SP, 1111 Constitution Ave. NW, Washington, DC 20224. Please do not send the enrollment form to this address.
The Privacy Act of 1974 requires that when we ask individuals for information about themselves, we state our legal right to ask for the information, why we are asking for the information, and how it will be used. We must also tell you what could
happen if we do not receive all or part of it, and whether your response is voluntary, required to obtain a benefit, or mandatory. Our legal right to ask for information is 5 U.S.C. 301 and Internal Revenue Code sections 6001, 6011, 6012, and
applicable regulations. The information will be used to enroll you in the Electronic Federal Tax Payment System (EFTPS). The information may not be disclosed except as provided by section 6103 of the Internal Revenue Code. We may give the
information to the Department of Justice and to other Federal agencies, as provided by law. We may also give it to cities, states, the District of Columbia, and U.S. commonwealths or possessions to carry out their laws. We may give it to foreign
governments because of tax treaties they have with the United States. Your response is mandatory if you are required by regulations to use electronic funds transfer to make your deposits. If you are not required by regulations to use electronic
funds transfer, your response is voluntary. If you do not provide all or part of the information, you may not be eligible to participate in the EFTPS. If you are required to use electronic funds transfer by regulation, you may be subject to penalties. If
you are not required to use electronic funds transfer to pay taxes owed, you need to pay the taxes due by another method.

Form 9787 (2/07)