Financial Institution Address definition

Financial Institution Address. Street: City: State/Province: Zip Code/Postal Code: Financial Institution Routing Number: Type of Account at Financial Institution: Provider’s Account Number with Financial Institution: Account Number Linkage to Provider Identifier: (Select one) ⬜ Provider Tax Identification Number (TIN) ⬜ National Provider Identifier (NPI) Note: If enrolled for 835 Electronic Remittance Advice (ERA), the provider must contact their financial institution to arrange for the delivery of the CORE-required Minimum CCD+ data elements needed for reassociation of the payment and the 835 ERA. SUBMISSION INFORMATION Reason for Submission: (Select one) ⬜ New Enrollment ⬜ Change Enrollment ⬜ Cancel Enrollment Include with Enrollment Submission: (Please specify which item you are including with your enrollment. At least one of these items is required by BCBSOK to complete your EFT enrollment.) ⬜ Voided Check ⬜ Bank Letter Authorized Signature: Printed Name of Person Submitting Enrollment: Printed Title of Person Submitting Enrollment: Submission Date: (Please continue to page 2 for Terms and Conditions) (EFT Enrollment Authorization Agreement, Page 2) TERMS AND CONDITIONS AGREEMENT AND AUTHORIZATION
Sample 1
Financial Institution Address. Street: City: State/Province: Zip Code/Postal Code: Financial Institution Routing Number: Type of Account at Financial Institution: Provider’s Account Number with Financial Institution: Account Number Linkage to Provider Identifier: (Select one) ⬜ Provider Tax Identification Number (TIN) ⬜ National Provider Identifier (NPI) Note: If enrolled for 835 Electronic Remittance Advice (ERA), the provider must contact their financial institution to arrange for the delivery of the CORE-required Minimum CCD+ data elements needed for reassociation of the payment and the 835 ERA. SUBMISSION INFORMATION Reason for Submission: (Select one) ⬜ New Enrollment ⬜ Change Enrollment ⬜ Cancel Enrollment Include with Enrollment Submission: (Please specify which item you are including with your enrollment. At least one of these items is required by BCBSTX to complete your EFT enrollment.) ⬜ Voided Check ⬜ Bank Letter Authorized Signature: Printed Name of Person Submitting Enrollment: Printed Title of Person Submitting Enrollment: Submission Date: (Please continue to page 2 for Other Data and Terms and Conditions) (EFT Enrollment Authorization Agreement, Page 2)
Sample 1
Financial Institution Address. Street: City: State/Province: Zip Code/Postal Code: Financial Institution Routing Number: Type of Account at Financial Institution: Provider’s Account Number with Financial Institution: Account Number Linkage to Provider Identifier: (Select one) c Provider Tax Identification Number (TIN) c National Provider Identifier (NPI) Note: If enrolled for 835 Electronic Remittance Advice (ERA), the provider must contact their financial institution to arrange for the delivery of the CORE-required Minimum CCD+ data elements needed for reassociation of the payment and the 835 ERA. SUBMISSION INFORM ATION Reason for Submission: (Select one) c New Enrollment c Change Enrollment c Cancel Enrollment Include with Enrollment Submission: (Please specify which item you are including with your enrollment. At least one of these items is required by BCBSOK to complete your EFT enrollment.) c Voided Check c Bank Letter Authorized Signature: Printed Name of Person Submitting Enrollment: Printed Title of Person Submitting Enrollment: Submission Date: (Please continue to page 2 for Other Data and Terms and Conditions.) OTHER DATA In addition to the maximum data elements required for EFT enrollment, BCBSOK will need the following information to finalize your request: Commercial payment option: c Weekly Government programs payment information: Blue Cross Medicare AdvantageSM claims are normally finalized weekly on Mondays.
Sample 1

Examples of Financial Institution Address in a sentence

  • Financial Institution Name Financial Institution Address Contact Name Telephone City State Zip Account Type Business Checking Savings Personal Checking General Ledger Routing Number Account Number (include all leading 0's) Authorized Signature on Account X Printed Name Title Date This ACH Authorization must be accompanied by a printed Voided Check or a letter from your financial institution stating the Customer's name, Routing Number, and Account Number.

  • If an account number is used as the “account code,” confidentiality of the account number is presumed to have been waived.The treasurer shall maintain all moneys of the political committee in a bank account or bank accounts used exclusively by the political committee and shall not commingle those funds with any other moneys.Type of account Financial Institution Address Account Number Account Code By signing this statement, I authorize agents of the State Board of Elections to inspect all accounts provided.

  • Account Number of 529 Plan or ESA Name of Current 529 Plan Manager or Custodian (Usually a Financial Institution) Address of Current 529 Plan Manager or Custodian City State Zip Code Contact Person Telephone Number Check this box if the Beneficiary on this account differs from the Beneficiary indicated in Section 2.

  • Remuneration and allowances to members of Unemployment Insurance Board 53.

  • Name(s) of Account Holder (as it appears on the cheque): Name of Financial Institution: Address of Financial Institution: Financial Institution Number (3 digits): Branch/Transit Number (5 digits): Account Number (7 - 14 digits): (If your Account Number starts with a zero, be sure to include the zero.

  • Name of Business: Business Address: Name of Financial Institution: Address of Financial Institution- Branch, City, State, Zip: Financial Institution Routing Number: Checking/Savings Account Number: Amount Authorized to be Debited Monthly (Must be in Compliance with Lease and will adjust with rent): Requested Draft Date (Must be in Compliance with Lease): Name (Please Print): Signature: Date: **A VOIDED check must be submitted, along with this completed form, for debits to be initiated.

  • As the child support obligor has non-exempt funds on deposit in an account at a financial institution: It is therefore ordered, adjudged and decreed that a withholding or deduction notice shall issue to: Financial Institution: Address: The child support obligor shall immediately notify the CJFS-OCSS of the number and description of the account from which support shall be deducted, and the name, branch, business address and routing number of the financial institution if not set forth above.

  • Company Name (Print) Financial Institution ABA Number Account Number at Financial Institution Financial Institution Name (Print) Financial Institution Address (Print) This authority is to remain in full force and effect until COMPANY, has received written notification from me (us) of its termination in such time and manner as to afford COMPANY, and FINANCIAL INSTITUTION a reasonable opportunity to act on it.

  • Name of the Financial Institution Address Phone Number Branch no.

  • Financial Institution Name ----------------------------------------------------- Financial Institution Address City, State ZIP ------------------- ----- -------- ---------------------------- Routing Number |: :| ---------------------------- ------------------------------------------------- Account Number ||.


More Definitions of Financial Institution Address

Financial Institution Address. City: Phone: ( ) Province: Postal Code: Bank ID Transit No: Bank Account No: Please attach a void cheque here, or include one official bank document. No counter cheques Examples of official bank documents:
Sample 1
Financial Institution Address. City: State: Zip Code: ABA Routing Number (9 digits) Checking Savings Account Number: I certify that this account belongs to the aforementioned account holder and is currently active and in good-standing. Institution Official's Printed Name Title Institution Official's Signature Date The financial institution must stamp this section to verify the information on this page: DAV National Headquarters Accounting Department E-mail: xxxxxxxx@xxxxxxx.xxx Phone: 000-000-0000 Fax: 000-000-0000
Sample 1

Related to Financial Institution Address

  • International Financial Institution means any bank in the top 1,000 (together with their affiliated companies) as measured by "Tier 1" capital or any broker/dealer in the top 100 as measured by capital.

  • UK Financial Institution means any BRRD Undertaking (as such term is defined under the PRA Rulebook (as amended from time to time) promulgated by the United Kingdom Prudential Regulation Authority) or any person falling within IFPRU 11.6 of the FCA Handbook (as amended from time to time) promulgated by the United Kingdom Financial Conduct Authority, which includes certain credit institutions and investment firms, and certain affiliates of such credit institutions or investment firms.

  • your financial institution means the financial institution nominated by you on the DDR at which the account is maintained.

  • UK Financial Institutions means any BRRD Undertaking (as such term is defined under the PRA Rulebook (as amended from time to time) promulgated by the United Kingdom Prudential Regulation Authority) or any person falling within IFPRU 11.6 of the FCA Handbook (as amended from time to time) promulgated by the United Kingdom Financial Conduct Authority, which includes certain credit institutions and investment firms, and certain affiliates of such credit institutions or investment firms.

  • Eligible Financial Institution means, as of the date of any assignment as contemplated in Section 8.07(a)(i), a commercial bank or financial institution (i) with a credit rating on its long-term senior unsecured debt of either (a) “AA-” or better from S&P or (b) “Aa3” or better from Xxxxx’x; and (ii) having shareholders' equity of not less than $5,000,000,000.

  • EEA Financial Institution means (a) any credit institution or investment firm established in any EEA Member Country which is subject to the supervision of an EEA Resolution Authority, (b) any entity established in an EEA Member Country which is a parent of an institution described in clause (a) of this definition, or (c) any financial institution established in an EEA Member Country which is a subsidiary of an institution described in clauses (a) or (b) of this definition and is subject to consolidated supervision with its parent.

  • International banking institution means an international financial institution of which the United States is a member and whose securities are exempt from registration under the Securities Act of 1933.

  • Reporting Financial Institution means any Member State Financial Institution or San Marino Financial Institution, as the context requires, that is not a Non-Reporting Financial Institution.

  • Non-Reporting Financial Institution means any Financial Institution that is:

  • Financial Institutions has the meaning set forth in the preamble in this Agreement.

  • Affected Financial Institution means (a) any EEA Financial Institution or (b) any UK Financial Institution.

  • Approved Financial Institution means any bank approved by Exchange in accordance with its credit review procedures or policies;

  • Canadian financial institution means (i) an association governed by the Cooperative Credit Associations Act (Canada) or a central cooperative credit society for which an order has been made under section 473(1) of that Act, or (ii) a bank, loan corporation, trust company, trust corporation, insurance company, treasury branch, credit union, caisse populaire, financial services cooperative, or league that, in each case, is authorized by an enactment of Canada or a jurisdiction of Canada to carry on business in Canada or a jurisdiction of Canada;

  • Financial institution means a Bank, Development Finance Institution, Non Banking Finance Company, Modaraba or an institution registered under relevant laws to provide financial services within or outside Pakistan.

  • Participating Financial Institution means a Financial Institution that has been approved by the Authority to enroll Qualified Loans in the Program and has agreed to all terms and conditions set forth in the Law and this Article and as may be required by any applicable federal law providing matching funding.

  • Licensed financial institution means a financial institution issued a license under this act.

  • banking institution means a bank, bank and trust company, trust company, savings bank, private bank, or a national banking association, organized and doing business under the provisions of any law of this state, or of any other state of the United States, or under the provisions of any law of the United States of America.

  • regulated financial institution means a state or nationally chartered bank, savings and loan association or savings bank, credit union, trust company, or other state or federally chartered lending institution or a regulated affiliate or regulated subsidiary of any of these entities.

  • Notification Email Address means the email address(es) designated by Customer in the Admin Console.

  • Master Street Address Guide or "MSAG" is a database of street names and house number ranges within their associated communities defining particular geographic areas and their associated ESNs to enable proper routing of 911 calls. "Meet Point" is a point of Interconnection between two (2) networks, designated by two (2) Telecommunications Carriers, at which one Carrier's responsibility for service begins and the other Carrier's responsibility ends.

  • Nonparticipating Financial Institution means a nonparticipating FFI, as that term is defined in relevant U.S. Treasury Regulations, but does not include a [FATCA Partner] Financial Institution or other Partner Jurisdiction Financial Institution other than a Financial Institution identified as a Nonparticipating Financial Institution pursuant to paragraph 2 of Article 5.

  • home address , in relation to a person, means—