Get 16.indd. Louisiana Small Group Business Employee Enrollment/change Form

This guide provides clear instructions on how to effectively complete the 16.indd. Louisiana Small Group Business Employee Enrollment/Change Form online. By following these steps, users can ensure that their information is accurately submitted for processing.

Follow the steps to complete the form with ease.

1. Press the ‘Get Form’ button to retrieve the form and open it in your preferred digital editor.
2. Begin by entering your personal information in the provided fields. This includes your name, date of birth, mailing address, and both daytime and home telephone numbers.
3. Next, provide your social security number and your provider number to ensure your records are associated with your application correctly.
4. In the financial institution information section, fill in the name, mailing address, and telephone number of your financial institution.
5. Input the required routing number and specify the type of account (checking or savings) by selecting the appropriate checkbox.
6. If you are opening a new account, enter your account number. If you are changing or cancelling direct deposit, indicate this clearly on the form.
7. Review the authorization agreement section. By signing and dating this form, you confirm your agreement to the terms outlined regarding direct deposits.
8. Before finalizing, double-check all entered information for accuracy, ensuring all required fields are completed.
9. Once completed, you can save your changes, download a copy of the form, print it for your records, or share it as needed.

Complete your forms online today for a seamless submission process.