Cigarette Tax Stamp Purchase ACH Payment Authorization Form – Cook County, IL

The Cigarette Tax Stamp Purchase ACH Payment Authorization Form is the Cook County Department of Revenue form that authorizes an ACH debit from the purchaser's bank account for a cigarette tax stamp purchase order.

The form collects the purchaser's name and registration number, address, a contact person, the last 4 digits of the bank account number on file, the total value of stamps purchased by type (Cook, Chicago/Cook, Evanston/Cook and Cicero/Cook) and the total tax due to be debited. A signer then certifies, under penalties provided by law, the authority to authorize that ACH payment amount for the stamps listed on the attached Cigarette Tax Stamp Purchase Order Form.

It belongs to the Cook County Tobacco Tax materials, which also include the Cook County Cigarette Tax Stamp Purchase Order Form, the Cook County Cigarette Tax Stamp Refund Claim Form and the Cigarette Tax Return 2707. This form does not order stamps, claim refunds or report tax: it only authorizes the debit that pays for an order placed on the Purchase Order Form. It is not a property tax document.

The form also has a check box for purchasers whose bank account information has changed. In that case the department must be notified with a new completed form showing the updated bank information.

Purchasers of Cook County cigarette tax stamps who pay by ACH debit complete this authorization and send it with their stamp purchase order. The Cook County Department of Revenue page says the Cigarette Tax Stamp Purchase Order Form must be completed by the Wholesale Tobacco Dealer in order to purchase Cook County tax stamps, and this form accompanies that order. The form asks for your registration number, so you should already be registered with the department.

The person who signs must have the authority to authorize the ACH payment amount; the signature block asks for a printed name, a title, a signature and a date.

You also use a new copy of this form if your bank account information has changed. Check the box provided and note the updated bank account information.

This form is not the self-pay Cigarette Tax Return 2707, which the county describes as the form for paying the Cook County Cigarette Tax on cigarettes bought over the internet, by mail, by phone or outside Cook County when no county tax has been paid. It is also not the refund claim form for unused or replaced stamps.

Submit this form each time you place a Cigarette Tax Stamp Purchase Order that you want paid by ACH debit, because it must be sent with that order form. If you reuse copies of the form, change the date to reflect the current date of your order. No separate due date is printed on it.

Without the authorization, the department has cause to reject or delay processing of your stamp purchase order.

If your bank account information changes, submit a new completed form with the updated information. The form asks you to allow 3-5 business days for the update to reach the department's financial institution, so plan your next order accordingly.

The form tells you to send it by email, together with the order form, to the Cook County Department of Revenue.

• Email: send the completed authorization and the Cook County Department of Revenue Cigarette Tax Stamp Purchase Order Form to [email protected]. The form states that failing to do so gives the department cause to reject or delay your order.
• Department details printed on the form: Cook County Department of Revenue, Cigarette Tax, 118 N. Clark Street, Room 1160, Chicago, IL 60602. Telephone: (312) 603-6961. Fax: (312) 603-5717. Web: www.cookcountyil.gov/revenue.

The form header says "Mail to" the Chicago address above, while the instructions in the body say to remit the form by email; call the department if you are unsure which applies to you. The authorization box must be checked or the form cannot be processed. FillingPDF lets you fill out and download the PDF; submission follows the channels above.