| 1 | AccountNumber | 10 | Text Field “10 Digits-0000123456 or R Followed by 9 Digits – R007000000” | Required |
| 2 | Period End [CCYYMMDD] | 8 | Text Field | Required |
| 3 | FEIN [No Dash] | 9 | Text Field | Required |
| 4 | Number of Employees | 5 | Text Field | Required |
| 5 | Total Tax Remitted | 13 | Must Include Decimal | Required |
| 6 | Total AL Income Tax Withheld | 13 | Must Include Decimal | Required |
| 7 | Overpayment Type C or R | 1 | Text Field | Required if claiming an Overpayment |
| 8 | Amount of Tax Due | 14 | Must Include Decimal | Required |
| 9 | Payment Method E (EFT Debit), V (EFT Credit), Z (zero tax due) or N (Negative Amount Due) | 1 | Text Field | Required |
| 10 | Funding Source Y (Yes), N (No) | 1 | Text Field | Required |
| 11 | Address (Employer’s) | 35 | Text Field | Required if EFT Debit and Funding Source is Y |
| 12 | City (Employer’s) | 33 | Text Field | Required if EFT Debit and Funding Source is Y |
| 13 | State (Employer’s) | 2 | Text Field | Required if EFT Debit and Funding Source is Y |
| 14 | Zip Code (Employer’s) | 5 | Text Field | Required if EFT Debit and Funding Source is Y |
| 15 | Zip Plus 4 (Employer’s) | 4 | Text Field | Required if EFT Debit and Funding Source is Y |
| 16 | Payment Date [CCYYMMDD] | 8 | Text Field | Required if EFT Debit |
| 17 | Bank Acct. Type: C (Checking), S (Savings) | 1 | Text Field | Required if EFT Debit |
| 18 | Bank Routing Number | 9 | Text Field | Required if EFT Debit |
| 19 | Bank Acct Number | 18 | Text Field | Required if EFT Debit |