N.H. Admin. Code § Saf-C 311.47 - Form RT 150, Registration for Electronic Funds Transfer Payment

(a) An applicant shall submit the following on form RT 150:

(1) Indication as to whether the application is a new registration or a change of document;

(2) Type of business entity, whether:

a. Corporation;

b. Limited liability company;

c. Proprietor;

d. Partnership; or

e. Other;

(3) Licensee's name, mailing address and telephone number;

(4) Federal employer identification number;

(5) Primary contact information, including:

a. Name; and

b. E-mail; and

(6) Bank account information, including:

a. Name of financial institution;

b. Routing transit number; and

c. Account number.

(b) The applicant's signature of record, title and printed name shall be required.

Notes

N.H. Admin. Code § Saf-C 311.47

Renumbered From Saf-C 311.40 Volume XXXV Number 1, Filed January 8, 2015, Proposed by #10753, Effective 1/1/2015.