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Get Magellan Healthcare Authorization Agreement for Accounts Payable EFT for EAP Payment 2010

from Magellan Health Services, Inc. via electronic funds transfers directly to a bank account, in lieu of a paper check, must complete this form. In order to receive electronic funds transfers, you must have a Form W-9 on file with Magellan and be the owner of the Taxpayer Identification Number (TIN) under which accounts payable invoices are paid by Magellan. Company/Partnership Information Company/Partnership Name: Address Line 1: Address Line 2: State: City: ZIP Code: Billing Contact Name.

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