The Wholesale Tobacco Dealer Cigarette Tax Stamp ACH Payment Application is the Cook County Department of Revenue form that lets a wholesale tobacco dealer authorize electronic debits from a bank account for Cigarette Tax Stamp Purchase Orders. It is a Cook County tobacco tax document, not a property tax form. On FillingPDF you can fill out the form online and download or print the completed PDF; the original PDF is published by Cook County, and the application is returned to the Department of Revenue by mail, as described below.
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What is Wholesale Tobacco Dealer Cigarette Tax Stamp ACH Payment Application – Cook County, IL?
The Wholesale Tobacco Dealer Cigarette Tax Stamp ACH Payment Application is the Cook County Department of Revenue form on which a wholesale tobacco dealer authorizes the Department to electronically debit or deduct payments for Cigarette Tax Stamp Purchase Orders from a named bank account.
The form collects the dealer's Cook County registration number, business name and street address, a contact person, and the bank details the Department will use: bank name, routing number, account number, account name and whether the account is a checking or a savings account. A certification block follows. By signing it, the signer states that they have authority to grant the debit authority, and acknowledges that the Department accepts the information on its face as true and correct and is not legally obligated to verify it independently.
It belongs to Cook County's Tobacco Tax, an ordinance that imposes a tax on the retail sale of cigarettes, other tobacco products and consumable vapor products within Cook County. Other documents on the Department's tobacco tax page do different jobs: the Cook County Cigarette Tax Stamp Purchase Order Form is what a Wholesale Tobacco Dealer completes to buy Cook County tax stamps, the Cook County Cigarette Tax Stamp Refund Claim Form requests refunds for unused or returned stamps, and the Home Rule Tax Registration Application is used to become a registered Wholesale Tobacco Dealer. This application only sets up the bank account used for payment.
Who needs to file Wholesale Tobacco Dealer Cigarette Tax Stamp ACH Payment Application – Cook County, IL?
Wholesale tobacco dealers who want the Cook County Department of Revenue to pay for Cigarette Tax Stamp Purchase Orders by ACH debit from their bank account complete this application. The form asks for the dealer's Cook County Tax Registration Number and business name, so it is completed by the dealer that holds the registration and grants the authority.
- Signer: the person signing must have the authority to grant the Department the right to debit or deduct ACH payments from the bank account listed. They enter their printed name, title, signature and date.
- Contact person: line 5 asks for the name and title of the owner, officer or designated person who has ACH payment responsibility.
- Dealers who change banks: a dealer that changes its bank account information must send an updated application before submitting its next Purchase Order.
The form's instructions do not allow a P.O. box as the dealer's address on lines 3 and 4. Retail purchasers and other taxpayers who pay Cook County cigarette tax on a different return do not use this form; it concerns only payments for tax stamp Purchase Orders.
When to file Wholesale Tobacco Dealer Cigarette Tax Stamp ACH Payment Application – Cook County, IL
Send an updated application whenever your bank account information changes, and send it before you submit your next Cook County Cigarette Tax Stamp Purchase Order. The form says to allow 3 - 5 business days for account updates, so plan the change ahead of the order.
The application authorizes debits for payments due on Purchase Orders submitted to the Department, which is why the bank details on file must be current when an order is placed. The form prints no calendar deadline or renewal date.
How to fill out Wholesale Tobacco Dealer Cigarette Tax Stamp ACH Payment Application – Cook County, IL
Enter your Cook County registration number
Line 1: write your Cook County Tax Registration Number.
Enter the business name and address
Line 2: the business name of the Wholesale Tobacco Dealer granting ACH payment authority. Lines 3 and 4: the street address and the city, state and ZIP; do not enter a P.O. box.
Identify the contact person
Line 5: the name and title of the owner, officer or designated person who has ACH payment responsibility. Line 6: that person's contact number.
Enter the bank name and routing number
Line 7: the bank or financial institution from which the ACH payment will be withdrawn. Line 8: its routing number.
Enter the account number and account name
Line 9: the account number from which the payment must be deducted. Line 10: the complete name of that bank or financial institution account.
Select the account type
Under CHECK ONE ONLY, mark either Check Account or Savings Account, not both.
Read the certification
The certification states that the signer has authority to grant the Department the right to debit the account, and that the Department accepts the information as true and correct without independent verification.
Print name, title, sign and date
The person signing enters their printed name and title, then their signature and the date, as the signature block requires.
Review, download and mail the PDF
Check the routing and account numbers and the address lines, then download or print the completed PDF from FillingPDF and mail it as described under How to submit.
How to submit Wholesale Tobacco Dealer Cigarette Tax Stamp ACH Payment Application – Cook County, IL
You return the completed application to the Cook County Department of Revenue by mail; the form names no other channel.
- By mail: Cook County Department of Revenue, Cigarette Tax, 118 N. Clark Street, Room 1160, Chicago, IL 60602.
- Certified mail: the form strongly suggests sending the application by certified mail.
- Questions: call the Department at (312) 603-6961, Monday through Friday from 8:30 a.m. to 4:30 p.m., or visit www.cookcountyil.gov/revenue.
Sign and date the certification before mailing. If you are replacing earlier bank information, send the updated application before you submit a new Purchase Order and allow 3 - 5 business days for the account update. FillingPDF lets you fill out and download the PDF; submission follows the channels above.
Common mistakes to avoid
- Entering a P.O. box on line 3 (Street Address) or line 4 (City, State, Zip); the instructions say not to enter a PO Box number.
- Marking both Check Account and Savings Account when the form says CHECK ONE ONLY.
- Changing bank accounts without sending an updated application before the next Cigarette Tax Stamp Purchase Order.
- Submitting a Purchase Order immediately after a bank change instead of allowing 3 - 5 business days for the account update.
- Leaving out the title of the contact person on line 5; the instructions ask for the name and title of the owner, officer or designated person with ACH payment responsibility.
- Entering a shortened name on line 10 instead of the complete name of the bank account from which the payment will be deducted.
- Mailing the application without the signer's printed name, title, signature and date, all of which the signature block asks for.
- Skipping certified mail, which the form strongly suggests for sending the application.
Frequently asked questions
What is the Cook County cigarette tax stamp ACH payment application?
It is a Cook County Department of Revenue form that authorizes the Department to electronically debit or deduct payments for Cigarette Tax Stamp Purchase Orders from the bank account a wholesale tobacco dealer lists on it. The signer's certification completes the authorization.
Is this a Cook County property tax form?
No. This application concerns Cook County's cigarette tax. A wholesale tobacco dealer uses it to give the Department of Revenue ACH debit authority for tax stamp Purchase Orders. It has no connection to Cook County property tax bills.
Who has to sign the ACH payment application?
The signer must have authority to grant the Department of Revenue the right to debit the listed bank account for Cook County Cigarette Tax Stamp payments. They print their name and title, sign and date the form. Line 5 separately names the contact with ACH payment responsibility.
Can I use a P.O. box on the application?
No. The instructions for lines 3 and 4 say not to enter a PO Box number. Give the street address of the Wholesale Tobacco Dealer, plus its city, state and ZIP code.
What if I change my bank account information?
Send an updated ACH Payment Application to the Cook County Department of Revenue before you submit your next Cigarette Tax Stamp Purchase Order. The form asks you to allow 3 - 5 business days for account updates.
Where do I mail the Cook County ACH payment application?
Mail it to Cook County Department of Revenue, Cigarette Tax, 118 N. Clark Street, Room 1160, Chicago, IL 60602. The form strongly suggests certified mail. It names no other way to return the application.
Can I fill out this application online?
You can fill out the PDF online on FillingPDF and download or print it. FillingPDF is independent and does not send the form to Cook County; you still mail the completed application to the Department of Revenue yourself.
How is this different from the Cigarette Tax Stamp Purchase Order Form?
This application sets up the bank account the Department debits. The Cook County Cigarette Tax Stamp Purchase Order Form is the separate form a Wholesale Tobacco Dealer completes in order to purchase Cook County tax stamps.
Who do I call with questions about the form?
Call the Cook County Department of Revenue at (312) 603-6961, Monday through Friday from 8:30 a.m. to 4:30 p.m. More information is at www.cookcountyil.gov/revenue.
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