EITC Formulaire de paiement par carte de crédit

EITC Formulaire de paiement par carte de crédit

Service Nova Scotia
IFTA Unit
International Fuel Tax Agreement (IFTA)
Credit Card Payment Form
RESET
PO Box 755
Halifax, Nova Scotia B3J 2V4
Phone: (902) 424-2850 Fax: (902) 424-0602
Phone: 1(800) 565-2336 Toll Free Within Nova Scotia
Email: [email protected]
Applicant/Carrier Information (Please print)
IFTA Account No.
Carrier Name:
Phone #:
Contact Name:
Fax #:
Ext #
Email:
Type of Transaction
New Licence or Licence Renewal (Fees are subject to change)
Annual Licence Fee (Licence expires on December 31 each year)
(A)
$
Number of sets required:
(B)
$
X $12.50
31.15
(Each vehicle licenced under IFTA requires a set of decals)
Total due
(A) + (B) $
Tax return payments and licence\decal fee payments will be processed as separate credit card transactions.
Unpaid balances accrue interest until paid.
Quarterly Tax Return (Include a copy of your billing notice)
Current period or outstanding amount
Year
Period
$
Unpaid balances accrue interest until paid.
Method of Payment
Payment by Cheque or Money Order
Make cheque or money order payable to the Minister of Finance.
Provide a separate cheque for (1) tax return payments and (2) licence\decal fee payments. A single
cheque received for a combined payment will be returned.
Payment by Credit Card
Card # (Visa/Mastercard/Amex)
Expiry:
(MM/YY)
Cardholder Name:
Signature
Date:
novascotia.ca/sns/pdf/ans-taxcomm-fuel-tax-ifta-credit-card-payment-form.pdf
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SNS-IFTA-CCP-V.08.09.16