Get Tricare For Life Eft Enrollment Online

Enrolling in the Tricare For Life Electronic Funds Transfer (EFT) program is essential for receiving payments quickly and efficiently. This guide will provide you with step-by-step instructions to complete the EFT Enrollment Form online.

Follow the steps to complete your Tricare For Life EFT Enrollment form online.

1. Press the 'Get Form' button to access the Tricare For Life EFT Enrollment form.
2. In Part I, indicate whether you are submitting a new EFT authorization, a revision to your existing authorization, or a termination request by marking the appropriate checkbox.
3. For Part II, enter the provider or supplier information including the name and legal business name. If applicable, provide the chain organization's name and the home office legal business name.
4. Provide the tax identification number as per IRS regulations. Select whether you want all locations under your Tax ID or specific group NPI and the payment locations for EFT.
5. In Part III, fill out the depository information section, including the name of your bank, account holder's name, address, and the nine-digit routing number for the account.
6. Ensure that you select the appropriate type of account (checking or savings) and attach a voided check for verification.
7. In Part IV, provide the contact person's information, such as their name, telephone number, and email address.
8. In Part V, sign and date the authorization section, certifying the details provided are accurate and agree to the terms outlined.
9. Finally, review all information for accuracy before saving changes, downloading, printing, or sharing the completed form.

Complete your Tricare For Life EFT Enrollment form online today for faster payment processing.