Get Application For Automatic Bank Draft Withdrawal - Silverscript

This guide provides you with clear instructions on how to complete the Application For Automatic Bank Draft Withdrawal - SilverScript online. By following these steps, you can ensure that your application is filled out accurately and submitted without any hassle.

Follow the steps to successfully complete your application.

1. Click the ‘Get Form’ button to access the form and open it in the online editor.
2. Start by entering your member information. Fill in the Member ID, last name, first name, and middle initial. Also, provide your permanent residence street address, city, state, ZIP code, and home phone number.
3. In the signature field, sign your name as the member or authorized individual. Enter today's date to confirm the application.
4. Select the type of account from which deductions will be made by checking one of the options: Checking, Savings, or Money Market.
5. Provide the necessary account information. Input the routing number, account number, and the name on the account as indicated on your check or deposit slip.
6. If you are the power of attorney for the member listed, check the box provided. Ensure to attach any necessary legal documents that verify this relationship to the application.
7. Contact Customer Care if you have any questions about the form at the number provided. They are available 24/7.
8. Attach a voided check or a deposit slip (for savings accounts only). Once everything is completed, return the form to SilverScript Insurance Company at the address provided.
9. Finally, you can save your changes, download a copy of the form, print it, or share it as needed.

Begin filling out your Application For Automatic Bank Draft Withdrawal online today.