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Forms and Other Resources for LaSalle Providers

WebRequest for Electronic Funds Transfer Note: This form allows your financial institution to pay the premiums for you automatically. As a convenience to me, I authorize Philadelphia … WebFirst Penn-Pacific Life Insurance Company (“Lincoln”) Electronic Funds Transfer (EFT) Authorization. This form allows Lincoln to collect payments from your checking or savings account for Life Insurance premium payment(s). By checking this box, I elect to Opt Out of using an electronic funds transfer for my Policy. Step 1 - Insured Information hero jet li movie english subtitles

AIG Claims, Inc.* DIRECT DEPOSIT AUTHORIZATION FORM

WebHOW TO OBTAIN FORMS A provider may obtain the EFT form only from the following sources: www.healthfirst.org/providers — Requires User Account Registration Applicable … WebEFT enrollment Electronic funds transfer enrollment You have chosen to enroll in an Electronic Funds Transfer. Please provide your first and last name, phone number and email address and click on send. You will receive enrollment directions shortly. Enrollment Help Guide PDF / 159kb Download hero journey paper assignment