Common Contracts
2 similar Electronic Funds Transfer Authorization Agreement contracts
Authorization Agreement – Instructions and Enrollment FormElectronic Funds Transfer Authorization Agreement • January 29th, 2020
Electronic Funds Transfer (EFT) allows Delta Dental member companies and their affiliates to send payment directly to your bank account. Explanations of Benefits will no longer be sent to you via the United States Postal Service, now offering a one stop solution for your Delta Dental patient’s EOBs using our National Portal. EFT is applicable to all providers at the Business (Tax Identification Number)/ Service Office indicated on your application unless otherwise noted. Please note that changes in your Tax Identification Number or Service Office address will terminate your EFT for that office; please complete a new EFT Authorization Agreement when modifying business information. General Instructions EFT Enrollment is applied to all providers at the specified business service office. You can add one or more business service offices for the Tax Identification Number or Employee Identification Number entered. A copy of a voided check or a bank letter must be forwarded to the address, ema
Authorization Agreement – Instructions and Enrollment FormElectronic Funds Transfer Authorization Agreement • June 7th, 2019
Electronic Funds Transfer (EFT) allows Delta Dental member companies and their affiliates to send payment directly to your bank account. Explanations of Benefits will no longer be sent to you via the United States Postal Service, now offering a one stop solution for your Delta Dental patient’s EOBs using our National Portal. EFT is applicable to all providers at the Business (Tax Identification Number)/ Service Office indicated on your application unless otherwise noted. Please note that changes in your Tax Identification Number or Service Office address will terminate your EFT for that office; please complete a new EFT Authorization Agreement when modifying business information. General Instructions EFT Enrollment is applied to all providers at the specified business service office. You can add one or more business service offices for the Tax Identification Number or Employee Identification Number entered. A copy of a voided check or a bank letter must be forwarded to the address, ema
