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Get Peia Eft Form
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How to fill out the Peia Eft Form online
The Peia Eft Form is essential for organizations wishing to initiate electronic fund transfers for payments related to WV PEIA, WV CHIP, and AccessWV. This guide provides clear, step-by-step instructions on how to complete the form online, ensuring that you meet all necessary requirements.
Follow the steps to complete the Peia Eft Form online
- Press the ‘Get Form’ button to access the Peia Eft Form and open it in your preferred online document editor.
- Indicate whether this is an initial request for EFT payments or a change to an existing enrollment by checking the appropriate box.
- Fill in the provider legal business name, federal tax ID number, and address details including city, state, and zip code.
- Provide the contact person's name and title for billing and payments, along with their telephone number and email address.
- Enter the financial institution's information, including the ABA (transit routing) number, checking account number, and the name and address of the financial institution.
- Specify the name on the checking account to ensure accurate processing of EFT payments.
- Prepare an original voided check to be submitted alongside the completed form, ensuring that the details match accurately.
- Sign the document in the designated area, print your name, indicate your title, and include the date of signing.
- List your phone number and fax number where prompted.
- Once all fields are completed, you can save your changes, download a copy, print it out, or share it as necessary, before sending it to the provided address.
Start filling out the Peia Eft Form online today for smooth and efficient payment processing.
Filling out an electronic funds transfer form, such as the Peia Eft Form, requires you to provide clear and accurate details. Start with your personal information, followed by your bank account and routing numbers. It’s crucial to review all entries before submission to ensure a smooth transfer.
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