AUTHORIZATION AGREEMENT FOR PREAUTHORIZED PAYMENTS
TC 95-583
Rev. 12/07

COMPANY NAME   KIT NUMBER 
I (we) hereby authorize The Commonwealth of Kentucky, hereinafter called The Commonwealth, to initiate debits entries to my (our) checking account indicated below and the depository named below, hereinafter called DEPOSITORY, to debit the same to such account.
DEPOSITORY NAME   BRANCH
CITY        STATE      ZIP 
TRANSIT/ABA NO.  ACCOUNT NO.  
This authority is to remain in full force and effect until The Commonwealth and DEPOSITORY has received written notification from me (or either of us) of it's termination in such time and in such manner as to afford The Commonwealth and DEPOSITORY a reasonable opportunity to act on it.
NAME  

SELECT YOUR PASSWORD
Must be 8 characters.

 DATE     SIGNED  _______________________________________________
E-MAIL ADDRESS  PHONE NUMBER 

MAIL TO:  Division of Motor Carriers  PO Box 2007  Frankfort, KY 40602

FAX TO: 502-696-1915 If faxing please include copy of voided check.

A voided check (or a copy of a voided check) is required with the completed form to authorize your filing of the Kentucky quarterly KIT
tax return using our website (http://transportation.ky.gov/dmc/). By using your KIT number and password you can access the screen needed to electronically file the return. As you submit the return, the system will automatically print a copy of the return for your records to show that it was timely filed. The return also tells you the amount due and the earliest that funds will be transferred from your bank account to The Commonwealth's account.
The earliest money will be transferred will be two days after the due date of the return. For example, if you file your
return on 10/20/08 and the due date is 10/31/08, the funds will not be transferred out of your account until 11/2/08.

A brief explanation of the ACH debit process may help explain this better. When you use a check to pay for
something, the bank of the individual receiving your check uses the bank transit number and your account number (both of which are preprinted on the bottom of your check), to tell them which bank and account number your money is in so they can transfer it into their account. The ACH debit process allows us to keep these two numbers on file for you and process the transfer of the money when you have submitted your return electronically.

This process eliminates the need for you to fill out a paper tax return and mail it to us. It eliminates the need for us
to process your return and prepare a deposit slip for our bank. Finally, it eliminates the need for either of our banks to process your check. Your bank statement will actually show that the amount deducted was transferred to The Commonwealth of Kentucky and was for your KIT Tax return.

While you already provide us with this information four times a year when you send us your check, this information
will be kept separate from your regular tax information in a secured location. Any changes to the password you selected or bank account number must be done in writing and will not be accessible through our normal call in procedures.