Get Direct Deposit Authorization Form Revissed 6-11-08.doc - Avmed

This guide provides clear and supportive instructions for completing the Direct Deposit Authorization Form Revissed 6-11-08.doc for Avmed. You will learn how to accurately fill out each section of the form to ensure your direct deposits are set up efficiently.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to access the Direct Deposit Authorization Form and open it in your editing software.
2. In the first section titled 'Payee Name (Legal Entity)', enter the legal name of the entity requesting direct deposit.
3. Fill in the 'Payee Number' as assigned by Avmed, ensuring it is accurate for proper processing.
4. Provide your 'Tax Identification Number', which is crucial for tax reporting purposes.
5. In the 'Email Address (Finance Dept Only)' field, input the email for finance-related communications.
6. Enter a contact number under 'Phone Number' that Avmed can use to reach you.
7. Complete the 'Contact First and Last Name' section with the name of the person responsible for managing this account.
8. In the 'Bank Name' field, indicate the name of your financial institution.
9. Fill in the 'Name on Account' as it appears on your bank account.
10. Provide the 'Routing Number', which is essential for directing funds to your bank.
11. Enter the 'Account Number' accurately to ensure deposits go into the correct account.
12. Attach a voided check; this is required for verifying your bank account information.
13. Read the authorization statement carefully, sign with your 'Authorized Signature', then print your name and title in the designated spaces.
14. Finally, indicate the date of signing.
15. After completing the form, save any changes, and print or share it as necessary, then send it to the AvMed Provider Service Center via mail or fax.

Complete your Direct Deposit Authorization Form online for a seamless payment experience.