Get Eps Eft User Authorization Agreement

This guide provides comprehensive and user-friendly instructions on completing the Eps Eft User Authorization Agreement online. By following these steps, users can ensure they accurately fill out the necessary sections of the form and submit it correctly.

Follow the steps to complete the Eps Eft User Authorization Agreement.

1. Press the ‘Get Form’ button to access the Eps Eft User Authorization Agreement form and open it in your document editor.
2. Begin by entering provider information. Fill out the required provider name, address (street, city, state, and zip code), and ensure all marked fields are completed.
3. In the provider identifiers information section, provide the Federal Tax Identification Number (TIN) or Employer Identification Number (EIN), National Provider Identifier (NPI), and select the provider type from the given options.
4. Complete the provider contact information. Input the primary contact's name, telephone number, email address, and any optional secondary contact information if applicable.
5. Fill in the financial institution information. Provide the name, address, and contact number of the bank, as well as the routing number and type of account (checking or savings). Enter your account number with the institution.
6. For the submission, indicate if you will provide a voided check or bank letter for verification. Ensure you tape the voided check or attach a copy of the bank letter as required.
7. Sign and date the authorization agreement in the designated areas. Include your printed name, title, phone number, and email address.
8. Finally, submit the completed form along with the voided check or bank letter. You can either fax or mail the documents as provided in the agreement instructions. Make sure to retain a copy for your records.

Start filling out your Eps Eft User Authorization Agreement online today for a smooth enrollment experience.