Get Tricare Premium Payment Credit Card & Eft Authotization Form
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the TRICARE Premium Payment Credit Card & EFT Authorization Form online
Completing the TRICARE Premium Payment Credit Card & EFT Authorization Form online is a straightforward process that allows users to manage their premium payments efficiently. This guide provides clear, step-by-step instructions for filling out each section of the form to ensure a smooth submission.
Follow the steps to complete your form online.
- Press the ‘Get Form’ button to obtain the form and open it in your editor.
- In Section I, enter the beneficiary information, including the TRICARE Reserve Select or TRICARE Retired Reserve sponsor name, DEERS Family ID or Social Security Number, mailing address, city, state, ZIP code, daytime phone number, and email.
- In Section II, select your payment option. If you choose Option #1 for Electronic Fund Transfer (EFT), input the type of account (checking or savings), bank routing/transfer number, bank account number, name of the financial institution, name(s) on the bank account, branch address, and branch telephone number.
- If you choose Option #2 for credit card payments, indicate the type of card (Visa or MasterCard), enter the cardholder name, billing address, city, state, ZIP code, credit card number, CVV/CVV2, and expiration date.
- In Section III, place your authorized signature, date the form, and print your name to confirm your authorization for International SOS Assistance, Inc. to process your payment request.
- Once all sections are completed, review the form to ensure accuracy. Save your changes, and then download, print, or share the completed form as needed.
Complete your TRICARE Premium Payment Credit Card & EFT Authorization Form online today to manage your premium payments effectively.
The claims address for TRICARE West is a critical component for ensuring your claims are processed without issues. For submission, always verify the latest claims address on the TRICARE West website or your claims paperwork. As you prepare your submission, including the TRICARE Premium Payment Credit Card & EFT Authorization Form can help manage associated costs. Accurate address information ensures that your claims are directed to the right place quickly.
Industry-leading security and compliance
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.