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Electronic Funds Transfer Mail-Order Form

Send me the following:

Electronic Funds Transfer Brochure (# 96-275)
TEXNET Enrollment Form (form # 00-107)
TEXNET Change Form (form # 00-941)
EFT Due Date Schedule (form # 00-843)
Payment Instruction Booklet (# 96-590)

Send to:
(All the following fields must be filled in.)
Business Name
Your Name
Street Address
City, State, Zip
E-mail Address