Get Premium Payment Credit Card & Eft Authorization Form

Filling out the Premium Payment Credit Card & EFT Authorization Form online is a straightforward process. This guide will walk you through each section and provide clear instructions to ensure your payment is processed smoothly.

Follow the steps to complete your Premium Payment Credit Card & EFT Authorization Form online.

1. Press the ‘Get Form’ button to access the Premium Payment Credit Card & EFT Authorization Form and open it in your browser.
2. In Section I, provide the beneficiary information. Fill in the fields for TRS/TRR/TYA sponsor name, TYA enrollee name, DEERS family ID/SSN, TYA enrollee SSN, mailing address, city, state, ZIP code, daytime phone number, and email.
3. In Section II, select either Option #1 for Electronic Fund Transfer (EFT) or Option #2 for credit card payments. If choosing EFT, include a VOIDED check or input your bank routing number and bank account number, along with the name of your financial institution and account holder names.
4. If you opt for credit card payment, complete the credit card section by indicating the type of card (Visa or MasterCard), the cardholder's name and billing address, and the credit card number, CVV/CVV2 code, and expiration date.
5. In Section III, provide your authorized signature and the date of completion, ensuring all information is accurate.
6. Finally, save changes, then download, print, or share the completed form as needed. Submit it via mail or fax to International SOS Assistance, Inc.

Complete your Premium Payment Credit Card & EFT Authorization Form online now to ensure your TRS/TRR/TYA premiums are processed timely.