Get Ez-blue Payment Option

The Ez-Blue Payment Option form is designed to facilitate hassle-free monthly premium payments by automated electronic withdrawals. This guide provides clear, step-by-step instructions to help users complete the form efficiently and accurately.

Follow the steps to fill out the Ez-Blue Payment Option form online.

1. Press the ‘Get Form’ button to access the form and open it for completion.
2. Verify with your financial institution that it can accept automated electronic withdrawals before proceeding.
3. Carefully fill out the BCBS Member ID in the designated space provided.
4. Enter the name of the member in the appropriate field.
5. If applicable, include the name of the depositor(s) if different from the member.
6. Provide a contact phone number for either the member or depositor.
7. Indicate the name of the bank and the city and state where the account is held.
8. Select either 'Checking Account' or 'Savings Account' by marking the appropriate checkbox.
9. Complete your name and address, including your city, state, and zip code.
10. Fill in the bank transit number.
11. Enter the depositor’s account number, as shown on the bottom left corner of a bank check.
12. Read the agreement carefully, and ensure you understand the terms before proceeding.
13. Sign and date the authorization agreement to confirm your understanding and acceptance.
14. Save any changes, then download, print, or share the completed form as needed.

Complete your documents online today for a smooth payment experience.