Ocial Security Number Address (Number & Street) Telephone Number City/Town State Joint Account Holder Name (Last, First, Middle Initial) Joint Account Holder s Social Security Number Signatures Pre-notification Please be sure the information on this form is accurate and complete. Attach a voided personal check in the space provided. NOTE: When a voided check is provided, we will use the Bank Account Number, and ABA Routing Number displayed on the check,.
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How to fill out the Aetna Electronic Funds Transfer (EFT) Authorization Form online
Filling out the Aetna Electronic Funds Transfer (EFT) Authorization Form online is a straightforward process that allows you to authorize automatic deposits to your bank account. This guide will provide step-by-step instructions to ensure that you complete the form accurately and efficiently.
Follow the steps to complete your EFT Authorization Form
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Provide your name by entering your last name, first name, and middle initial in the designated fields. Make sure to fill this information clearly as it is essential for identification.
- Enter your Social Security number in the appropriate section. This information is used for verification purposes.
- Fill out your address, including the number and street, city/town, state, and ZIP code.
- If applicable, provide information for a joint account holder by entering their name, Social Security number, and other requested details.
- Indicate the type of account by checking either 'Checking' or 'Savings'.
- Provide the name of the financial institution where your account is held.
- Enter your bank account number and the ABA routing number (both found on your checks).
- Review the agreement section and acknowledge your consent by signing and dating the form. If you have a joint account holder, their signature is also required.
- Attach a voided personal check in the space provided or, if applicable, include a letter or bank statement confirming the account details, ensuring that it has the necessary signature from a bank official.
- Once all sections are completed accurately, save your changes. You can then choose to download, print, or share the form as needed.
Complete your Aetna Electronic Funds Transfer Authorization Form online today to streamline your payment process.
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