Ez tag store5/15/2023 ![]() ![]() Termination of access to the EZTAG service will not absolve you from liability to the State of The EZTAG web interface to correct bank account information if necessary, and then post the associatedĮntries again within one business day after receiving notice of the ACH failure.īIS and the State of Tennessee reserve the right to terminate your access to the EZTAG service at any time. You will be notified via email if there is an ACH failure (may be called “ACH return”). ACH transactions may fail to processįor a number of reasons, including but not limited to insufficient funds and invalid account information. Monthly debits to your bank account will be made via ACH transactions. Monthly debits will be based on the entries (temp tags printed) that have been posted in the previous month. I agree to use the reporting features within the EZTAG online interface to reconcile authorize Business Information Systems (BIS) or Tennessee Department of Revenue to withdraw (debit) fundsįrom the bank account provided in this form on a monthly basis for use of the EZTAG service, which are toīe remitted by BIS or directly taken by the State of Tennessee on my behalf to the State of Tennesseeĭepartment of Revenue. I hereby authorize Harris County to periodically charge my Credit/Debit Card and/or debit my bank account for the amount(s) necessary to satisfy myobligations under this Agreement and the Application provided herein.* SIGNATURE NECESSARY TO AVOID PROCESSING DELAYS.STORE HOURS7:30 a.m.-5:30 p.m. I have indicated in my Application either the Credit/Debit Card payment option or the EFT payment option and further, have provided the County with either my Credit/Debit Cardnumber or my bank account number to effectuate the establishment of my Prepaid Account. I acknowledge that I have read,understand, and will be bound by the terms of this Agreement. _ Deposit amount _Para ayuda en Español, por favor llama 28I, _, hereby make application to use the EZ TAG which will allow me to obtain passage on the Harris County Toll Road System via designated EZ TAG lanes. _Routing No.Signature _ Date_* Please submit your $100.00 prepaiddeposit, $15.00 (or applicable amount topurchase your tag(s) AND a voidedblank check with this application.Vehicle #1License Plate (State)License Plate (State)*Itemized Monthly Statement (See Fee Schedule on reverse)_Yes _No* Statements available on-line at no additional charge.For Office Use OnlyEZ TAG Number_Number _Vehicle Description (Year) _Color _Make & Model _Vehicle #2EZ TAG Number_Number _Vehicle Description (Year) _Color _Make & Model _Vehicle #3EZ TAG NumberLicense Plate (State)_Number_Vehicle Description (Year) _Color _Make & Model _Number of TAGS requested _Account number assigned _Clerk I.D. ![]() Debit ■Electronic Funds Transfer (EFT)Harris County has authorization to debit my checking accountas necessary at the bank indicated below.This authorizationwill remain in effect until Harris County has received writtennotice of its termination and has reasonable opportunity to actupon it.Bank NameAcct No. This authorization will remain ineffect until Harris County has received written notice of itstermination and has had reasonable opportunity to actupon it.Prepayment Amount: (check one)■ $40.00 Minimum or■ Estimated monthly usage in the amountof $_, whichever is greater.■ American Express■ Discover Card■ MasterCard■ VISASignature_Date_STORE HOURS7:30 a.m.-5:30 p.m. Date_Debit Card ■ Credit Card ■Account no._Harris County has authorization to charge my Credit/DebitCard account as necessary to maintain the minimumbalance indicated below. Keep agreement for your records.Personal Information (Please Type or Print)VEHICLE INFORMATION FOR EACH EZ TAG REQUESTEDCredit/Debit Card:Check oneExp. Monday-Friday8:00 - 4:30 Saturda圜omplete and sign this form and mail to 330 Meadowfern Drive, Houston, Texas 77067. Monday-FridayLast Name _First name_Middle Initial_Other Authorized Agent(s)_Street Address_City_State_Zip Code _Work Phone ( )_ ext._Home Phone ( ) _Driver’s License Number (State)_(Number) _Email AddressMethod of Payment (Check One)STORE HOURS7:30 a.m.-5:30 p.m. Sam Houston Pkwy N., Hou., TX 77043 (Relocation Fall ‘06)STORE HOURS7:30 a.m.-5:30 p.m. GREENSPOINT AREATOWN & COUNTRY AREAWESTPARK AREASOUTHWEST AREABrant RockWestparkTollwayDairy-AshfordOld WestheimerWilcrestSam Houston TollwayUS 59 SouthWestparkTollwayIH 610 West330 Meadowfern Dr., Houston, TX 77067 906 W. ![]()
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