Get Authorization Agreement For Electronic Wic ...

Filling out the authorization agreement for electronic WIC payments is essential for ensuring smooth processing of transactions. This guide will provide step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Click the ‘Get Form’ button to obtain the form and access it in your preferred editor.
2. Enter your WIC Vendor ID number. This identifier is important for your record and will help in processing your form correctly.
3. Provide your WIC Vendor Store Name, ensuring it's accurate and matches your official records.
4. Fill in the WIC Vendor email address where you wish to receive electronic statements. Double-check for typos to avoid communication issues.
5. Complete the WIC Vendor Contact Name, as it will identify the person responsible for your account.
6. Provide the name of your financial institution. This should be the bank where your account is held.
7. Input your bank routing number, ensuring it is exactly 9 digits long. Confirm with your bank to avoid errors.
8. Enter your bank account number, which can be up to 25 characters. Again, verify this information with your financial institution.
9. Complete the address information, including Address 1 and Address 2 (if applicable), City, State (abbreviated), and Zip Code. Ensure that all entries are correct.
10. The authorized representative must certify the information by providing their signature. Ensure that the signature is complete with no initials.
11. Print the name of the representative filling out the form, along with their phone number. This will be crucial for any follow-ups.
12. Date the signature in the designated area. This establishes the timeline for the authorization.
13. Once all fields are completed, save your changes. You can then choose to download, print, or share the completed form as needed.

Begin filling out your electronic WIC authorization agreement online today.