Get Assurant Health Eft Authorization Form

Filling out the Assurant Health Eft Authorization Form online can streamline your billing process by allowing automatic transfers from your bank account. This guide provides you with clear, step-by-step instructions to complete the form efficiently.

Follow the steps to complete the online form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your name in the designated field. Ensure that you provide your full legal name as it appears on your identification documents.
3. Provide your Social Security number in the specified section. This information is necessary for accurate identification and processing.
4. Next, fill in your home phone number, including the area code, to ensure that you can be contacted if necessary.
5. Enter your work phone number with the area code. This additional contact information may be useful for follow-up purposes.
6. In the financial institution section, include the name of your bank or credit union to which the funds will be transferred.
7. Specify the branch location of your financial institution, including the city, state, and ZIP code.
8. Provide the routing or transit number for your bank. This number is essential for initiating electronic transfers.
9. Enter your account number accurately. This will be the account from which funds are debited.
10. Indicate whether the account is a checking or savings account by selecting the appropriate option.
11. Review the authorization statement carefully. This confirms your permission for the Time Insurance Company to initiate debit and credit transactions to your account.
12. Sign the form in the designated signature field, and include the date of signing.
13. After completing all sections, you can save changes, download the completed form, print it for your records, or share it as needed.

Take the next step in your health management by completing the Assurant Health Eft Authorization Form online today.