eftnys

STATE OF NEW YORK CHILD SUPPORT PROCESSING CENTER

EMPLOYER REGISTRATION FOR ELECTRONIC FUNDS TRANSFER

YOU MUST COMPLETE AND SUBMIT THIS INFORMATION BEFORE MAKING YOUR FIRST ELECTRONIC TRANSMISSION TO THE NYSCSPC.

Authorization is not granted for debit entries. The NYSCSPC does not accept reversing entries.

Company Name: D~&-A~&E 7--z.&a ,'i' C O C P ~ K ~ L ~ T C O J

I

ACH Company Name: a 1 l- M L d & 7- 0 1 5 (Print the 16 alphanumeric characters that will be entered in the Company Name field on your ACH Batch Header Record.

FEIN: 5 1 0 3 h 4 3 6 7 (FederalEmployer~dentification Number)

- ODFl [Bank Name]: a 1 LM I hl I R U S i- Employer Child Support Contact:

Name: ~ O ~ L ) E G(I/C*Q

Phone: 302-760 - A g q b

Fax: 02 - [p 0 y 13 V

E-Mail: -SUZANNE, ~ - I ~ E A J S @ , S T & T E , W , U S

Address: CJ .<46

Please complete all information. Attach the child support account information requested. If you have questions, please call NYSCSPC EFT Customer Support at (888) 208-4485.

E-Mail, Fax or Mail this form and your employee account information to:

E-Mail: nyscspceft@,acs-inc.com FAX: (5 18) 438-0759 MAIL: Post Office Box 15363

Albany, New York 122 12-5363

NOTE: I will be using Expertpay ADP Paychex Ceridian (ck one)

My Bank Other