Common Contracts
1 similar null contracts
LOUISIANA MEDICAID DIRECT DEPOSIT ELECTRONIC FUNDS TRANSFER (EFT) AUTHORIZATION AGREEMENT GENERAL INFORMATIONOctober 13th, 2020
• Only an authorized representative may sign this form. This authorized representative must be someone designated to enter into a legal and binding contract with Louisiana Medicaid. This person must be someone currently listed on the Disclosure of Ownership as either an owner or managing employee. Any other signature will be grounds for rejecting this form.
