Get Automatic Bank Draft Withdrawal - Silverscript

This guide provides step-by-step instructions on how to complete the Automatic Bank Draft Withdrawal form for SilverScript online. By following these detailed steps, users can efficiently set up their bank withdrawals to manage their premiums seamlessly.

Follow the steps to fill out the form accurately and effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. In the 'Member Information' section, enter your Member ID, last name, first name, and middle initial in the designated fields.
3. Provide your permanent residence street address, city, state, and ZIP code in the respective fields.
4. Input your home phone number to ensure that the company can contact you if needed.
5. In the 'Your Signature' field, sign your name, and then indicate today’s date.
6. Remember to enclose a check if you are setting up Automated Clearing House (ACH) transfers from a checking account, or include a Savings Account Direct Deposit form to set up ACH on a savings account.
7. Review the information you provided for accuracy. Ensure that there are no alterations to the authorization details.
8. After checking everything, you can save your changes, download a copy of the form, print it out, or share the completed form as needed.

Take control of your payments today by completing the Automatic Bank Draft Withdrawal form online.