Get Florida Blue Eft Enrollment

Filling out the Florida Blue Electronic Funds Transfer Enrollment form is essential for accessing direct deposit payments. This guide provides a comprehensive walkthrough of each section of the form to ensure a smooth and efficient enrollment process.

Follow the steps to complete your EFT enrollment effectively.

1. Click ‘Get Form’ button to obtain the Florida Blue EFT Enrollment form and open it to begin filling it out.
2. In the first section of the form, enter your name and phone number clearly. Ensure that you include the title of your position as part of your identification.
3. In the next section, you will need to authorize Florida Blue to initiate credit and debit entries on your designated account. Carefully read the authorization statement and then sign and date the form.
4. Next, fill out the account information. If all payment locations are linked to the same bank account, indicate this clearly on the payment address line. If not, complete separate forms for each bank account.
5. Provide the account holder's name, the tax identification number, and the Florida Blue number for the billing provider. If applicable, include the billing provider national provider identifier (NPI).
6. In the financial institution information section, include the name and address of your bank, as well as the transit/ABA number and your account number. Double-check for accuracy.
7. Finally, attach the original voided check or a letter from your bank that confirms your account details. Make sure this is placed securely where indicated on the form.
8. Once you have completed all sections and attached the necessary documents, save your changes and consider printing the form for your records. Mail the final document to the designated Florida Blue address.

Complete your Florida Blue EFT Enrollment form online today to start receiving payments efficiently.