Get Eft Form - El Paso First Health Plans, Inc.

Filling out the Electronic Funds Transfer (EFT) Form for El Paso First Health Plans, Inc. can streamline the process of receiving payments. This guide will take you through each step of the online form to ensure you accurately complete it.

Follow the steps to fill out the EFT Form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the provider or group name in the designated field.
3. Next, input the NPI number, which is necessary for identification.
4. Fill in the tax ID number in the corresponding field.
5. Authorizing El Paso First requires you to select either 'Checking Account' or 'Savings Account' in the respective checkbox.
6. Provide the name of your depository financial institution in the depository name field.
7. Indicate the branch of your financial institution.
8. Enter the city and state associated with the depository.
9. Fill in the zip code for the corresponding area.
10. Input your account number as it appears on your bank documents.
11. Provide the routing number, which is essential for ACH transactions.
12. Next, confirm that the authorization will remain active until you provide written notification for termination.
13. Enter the names of the individuals authorizing this agreement in the respective field.
14. Include the title of the person or persons signing the form.
15. Record the date of filling out the form.
16. Finally, complete the form with the signature of the authorized individual.
17. Ensure to attach a voided check to the completed form.
18. Once all fields are accurately filled, you can save your changes, download the form, print it, or share it as needed.

Complete your EFT Form online today to ensure timely payments.