Get Eft Authorization Form

The Electronic Funds Transfer Authorization Form is essential for authorizing financial transactions directly into your bank account. This guide will provide clear and concise steps to help you complete the form online.

Follow the steps to effectively complete the Eft Authorization Form online

1. Press the ‘Get Form’ button to access the Electronic Funds Transfer Authorization Form. This allows you to open the document in your online editing tool.
2. Fill in the Provider Information section. Provide the legal name of the institution, any 'Doing Business As' name, and the full address, including street, city, state/province, and ZIP code.
3. Complete the Provider Identifiers Information section. Enter the Provider Federal Tax Identification Number (TIN) or Employer Identification Number (EIN), and your National Provider Identifier (NPI). Ensure that these identifiers are accurate and reflect your business.
4. In the Provider Contact Information section, include the contact person's name, telephone number, and email address for any communication regarding the EFT process.
5. Proceed to fill in the Financial Institution Information. This should include the official name and address of your bank, along with the financial institution's telephone number, routing number, and the type of account you are using (checking or savings). Provide your account number.
6. Complete the Submission Information section. Indicate the reason for submission: whether it is a new enrollment, a change, or a cancellation. Attach necessary documentation such as a voided check or bank letter for identification purposes.
7. Sign the form in the Authorized Signature section. This includes both an electronic signature and a printed name of the signatory, along with their title and the submission date.
8. After filling in all necessary sections and verifying the accuracy of the information, save your changes. You may download, print, or share the completed form as required.
9. Finally, submit the form and any attachments to Mayo Clinic Health Solutions via mail or fax at the address or number provided in the form.

Complete your Eft Authorization Form online today to ensure smooth processing and transactions.