Get Anthem 27248caeenabc 2012-2025

Completing the Anthem 27248CAEENABC authorization request form online is a straightforward process. This guide will provide you with detailed, step-by-step instructions to ensure that you fill out the form accurately and effectively.

Follow the steps to complete the Anthem 27248CAEENABC form online.

1. Press the ‘Get Form’ button to access the Anthem 27248CAEENABC document. This action will open the form in your preferred editing software or platform.
2. In Section 1, provide the required group information. Fill in your group name, group number, legal company name, street address, city, state, ZIP code, fax number, and email address. Ensure that all details are accurate and up-to-date.
3. In Section 2, enter the financial institution information. Include the name and street address of the bank, along with the city, state, and ZIP code. Fill in the transit routing number (9-digit ABA routing number) and account number. Select the type of bank account from the provided options (personal or business checking/savings).
4. Review the authorizations. Read and understand the terms stating that this authorization takes effect upon receipt by Anthem and remains in force until written notice of termination is provided. Make sure you understand your rights and responsibilities regarding this authorization.
5. In the signature section, input the date, printed name of the signer, and provide the signature to authorize the transaction. Ensure that the signer is an authorized contact as per Anthem’s records.
6. If you wish to terminate this agreement, fill out Section 3. This section only needs to be completed if you are ending the authorization. Provide the printed name of the signer, signature, and date. The termination request must be properly signed and can be sent on company letterhead or using this form.
7. After completing the form, save any changes you made. You can then download a copy for your records, print the completed document, or share it as needed.

Start filling out the Anthem 27248CAEENABC form online today to manage your financial arrangements efficiently.