Authorization For Electronic Fund Transfer - Metlife printable pdf download

Authorization For Electronic Fund Transfer - Metlife

Electronic Funds Transfer (EFT) Payment Option

Thank you for choosing the Electronic Funds Transfer (EFT)

payment option. EFT provides a new payment option for list

billed groups to remit premium electronically from their bank

to ours, without the resources and costs associated with

requesting and issuing a manual check each month. To

implement the EFT payment option, a group/division must

complete the attached Authorization for Electronic Fund

Transfer form and attach a copy of a voided business check.

Each group/division will continue to receive a list billing

statement at the same time they do now. The difference on

the bill is the last page states “Amount To Be Drafted”. The

premium will be drafted from the groups’ authorized bank

account on each Bill Due Date. The effective date of a

group on EFT payment option will be contingent on when we

receive the completed authorization form and load the

groups’ account information into our systems.

Mail this completed form to:

MetLife

Small Market

P.O. Box 14593

Lexington, KY 40512-4593

Fax to:

Attn: MetLife-Small Market

Subject: EFT Authorization Form

Fax: (888) 505-7446

Small Market

EFTFORM02 0108

Authorization For Electronic Fund Transfer - Metlife