Get Electronic Funds Transfer Authorization Enrollment Form

Filling out the Electronic Funds Transfer Authorization Enrollment Form is an essential step for users wishing to set up automatic payments for their insurance policies. This guide will provide you with clear and concise instructions to effectively complete this form online.

Follow the steps to fill out the form with ease.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Enter the agency name clearly at the top of the form, ensuring accuracy.
3. Fill in the name of the person insured in the designated field.
4. Include your policy number, which can typically be found on your insurance documents.
5. Provide your complete address, including city, state, and zip code.
6. Fill in your home phone number for contact purposes.
7. Include your work or day phone number, if applicable.
8. Authorize deductions by clearly stating you grant Montgomery Insurance Companies permission to withdraw payments from your specified banking account.
9. Specify the bank name where your account is held.
10. Provide the bank routing number, essential for processing the electronic transfer.
11. Enter your checking account number for the bank account from which payments will be deducted.
12. If applicable, input your member identification number for a credit union account.
13. Remember to attach a voided check to ensure your bank account information is clearly understood.
14. Select your preferred payment withdrawal date range: from the 1st through the 28th of the month.
15. Indicate whether you would like written notification regarding withdrawals and the terms of that notification.
16. Choose your preferred pay plan option: annual, quarterly, or monthly.
17. Sign and date the form where indicated to authorize the automatic deductions.
18. If the account holder is someone other than the insured, ensure they also sign and date the form.
19. Finally, review your form for accuracy and clarity, then save changes, download, print, or share as needed.

Complete your form online today to set up your payments effortlessly.