Common Contracts
1 similar Retired Employees contracts
FOR RETIRED EMPLOYEESRetired Employees • April 27th, 2017
A RETIREE INFORMATION BENEFITS ID (BID) (THIS IS THE 8 DIGIT ALPHA-NUMBERIC NUMBER FOUND ON YOUR BLUE CROSS BLUE SHIELD CARD AFTER UTS0 OR UTZ0) FIRST NAME M.I. LAST NAME MAILING ADDRESS CITY STATE ZIP EMAIL ADDRESS PHONE NUMBER (XXX) XXX-XXXX AUTHORIZATION AGREEMENT FOR DIRECT PAYMENTS VIA ACHI / We authorize The University of Texas System on behalf of the Office of Employee Benefits, hereinafter referred to as “UT Benefits Billing”, to initiate recurring direct payments via ACH in the amount referenced below to the checking or savings account indicated below. I / We agree that ACH transactions I/we authorize comply with all applicable law. If the amount initially charged should change in the future, UT Benefits Billing will provide written notification of the new amount 10 calendar days before the first scheduled transaction date for that new amount. The debit to the account referenced below will occur on the due date or within 2 business days of the due date.UT Benefits Bi
