Get Map 811 Addendum E

This guide provides a clear and supportive walkthrough for filling out the Map 811 Addendum E form online. Whether you are completing the direct deposit authorization or cancellation, these instructions aim to assist users of all experience levels in navigating the process with ease.

Follow the steps to complete the Map 811 Addendum E effectively.

1. Press the ‘Get Form’ button to access the Map 811 Addendum E form and open it in your online editor.
2. Fill in the provider information, including the provider name, provider number, and NPI (National Provider Identifier). Ensure that all entries are accurate and complete.
3. Enter the address details: provide the physical address, city, state, and zip code. Also, include the telephone number where the provider can be reached during normal business hours.
4. Identify a contact name by entering the individual’s name who can be reached at the provided telephone number.
5. Indicate whether this form is for a new enrollment or an institution/account change by marking the appropriate option.
6. Provide the bank name and, if needed, the branch or correspondent bank name. Fill in the city, state, and zip code for the financial institution as well.
7. Enter the transit/ABA number, which is a nine-digit number identifying your financial institution. This number can often be found on the bottom of your checks.
8. Input your account number, ensuring that it accurately reflects your financial institution's records.
9. Select the account type by marking the appropriate box indicating whether you prefer the deposit into a checking or savings account.
10. Sign and date the form, providing the title of the individual signing it.
11. If you wish to cancel the direct deposit, mark the cancellation block, sign, and date the form. Include the title of the individual signing.
12. Finally, once you have completed the form, you can save your changes, download, print, or share it as needed.

Complete your Map 811 Addendum E online today for a seamless direct deposit process.