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Get Ca Cdi-177 2016
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How to fill out the CA CDI-177 online
The CA CDI-177 electronic funds transfer authorization agreement allows users to authorize electronic invoice payments to the California Department of Insurance. This guide will provide you with step-by-step instructions to successfully complete the form online.
Follow the steps to fill out the CA CDI-177 online
- Click the ‘Get Form’ button to obtain the CA CDI-177 form and open it in your document editor.
- In Section I, enter your company's information, including the company name, NAIC number (if applicable), DBA, company ID number, and business address. Ensure that the details match your invoices.
- In Section II, fill in the information for the EFT contact person. This individual will be responsible for creating a user profile and managing EFT ACH debit payments.
- In Section III, provide the name and contact information of the authorized representative who will approve the use of ACH debit for payments. Include their signature and date.
- If necessary, review Section IV, which is designated for CDI accounting use only.
- After completing the form, email the finalized document to arbilling@insurance.ca.gov. Keep a copy for your records.
Complete and submit your documents online to streamline your payment process.
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