Enrollments zurichna com 2026

1. Click ‘Get Form’ to open the enrollment form in the editor.
2. Begin by selecting your purpose for filling out the form: New Enrollment, Change Enrollment, or Cancel Enrollment. Ensure you check the appropriate box.
3. Fill in your Provider Name as it appears on the W-9 and provide your Taxpayer ID Number and NPI if required.
4. Next, complete the Banking Information section. Choose between Checking or Savings account types and enter the Financial Institution Name and Address along with the Transit (Routing) / ABA Number and Account Number.
5. In the Authorization Signatures section, ensure that an authorized signer on the bank account provides their name, signature, address, phone number, and title.
6. Attach a Voided Check or Deposit Slip as required based on your account type along with a W-9 form.
7. Once completed, scan all documents and email them to MBR-EFT-Enrollment@zurichna.com as attachments.

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