Get TRICARE Premium Payment Credit Card & EFT Authotization Form
Auto Payments By signing this form you are authorizing International SOS Assistance, Inc. as applicable, to initiate debit/credit card or EFT charges (and/or corrections to previous debits/charges) from your account with the financial institution identified on this form for payment of TRS/TRR premiums. A fee of $20 may be applied for insufficient EFT funds. Important note for auto monthly payments: Payment of any past due amount is required to set up an automated monthly payment account. If you.
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