Get Eft Form Template 2020-2026

Filling out the Eft Form Template online is a straightforward process, designed to enable electronic fund transfers for claims payments. This guide will provide you with clear, step-by-step instructions to ensure your form is completed accurately and submitted correctly.

Follow the steps to complete the Eft Form Template online.

1. Click the ‘Get Form’ button to access the Eft Form Template and open it in your preferred online editing tool.
2. Indicate whether this is an initial request for EFT payments or a change to an existing enrollment by checking the appropriate box.
3. Enter your organization's legal business name as it appears in official documents.
4. Provide the Federal Tax ID number associated with your organization.
5. Fill in the address fields, including street address, city, state, and zip code, to ensure accurate identification of your organization.
6. Supply the name and title of the contact person responsible for billing and payments, along with their telephone number and email address for future correspondence.
7. Complete the financial institution information by entering the ABA (Transit Routing) Number and the Checking Account Number where EFT payments will be deposited.
8. Add the name of your financial institution, along with its telephone number, address, city, state, and zip code.
9. Enter the name on the checking account linked to the provided account numbers.
10. Remember to attach an original voided check with the completed form, as this step is necessary for verification.
11. Sign the form to authorize EFT payments, print your name, and include your title.
12. Provide your phone number and the date the form is signed.
13. Once the form is completed, save your changes, and download the file if necessary. You may also print or share it for your records.
14. Finally, send the completed form to the designated address for EFT Enrollment.

Get started by filling out the Eft Form Template online today!