Get Group Contact Change Form - Selectaccount

Filling out the Group Contact Change Form - SelectAccount online is a straightforward process that allows you to efficiently update your group's contact information. This guide provides step-by-step instructions to help you complete the form accurately and make necessary changes.

Follow the steps to fill out the form successfully.

1. Click 'Get Form' button to initiate the process and open the form in your preferred editor.
2. In the Group Information section, enter your group's name and SelectAccount Group number in the designated fields.
3. In the General Information Change section, check the boxes next to the information you wish to change, including new group name, address, and primary group contact details.
4. Provide the new primary group contact's name, title, phone, and fax number, if applicable. Indicate if the same changes should apply to Report Contact, Email, and Billing Contact.
5. If adding an additional contact, fill in their name, phone number, email address, and fax number in the provided fields.
6. For Report Contact Information Change, check the boxes for changes or new additions, and specify how the report contact should receive claim reimbursement payment reports (by email or fax).
7. Select the preferred report format from the options provided.
8. In the Billing Contact Change section, include the name, address to send invoices, phone number, and email of the new billing contact.
9. For Agency/Agent Affiliation Change, fill in the agency name, address, and the effective date of change.
10. After completing all sections, ensure accuracy and sign the form. Add the date of signing.
11. Finally, you can save changes, download, print, or share the completed form as needed.

Take a moment to fill out the Group Contact Change Form online today to ensure your group's information is up to date.