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Click ‘Get Form’ to open the EFT Funds Agreement form in the editor.
Begin by entering your Supplier Name and Federal Tax ID No. or Supplier Code in the designated fields. Ensure accuracy as this information is crucial for processing payments.
Provide your Phone Number and Remit To Address(es). If you have multiple addresses, use additional sheets as necessary. Fill in each address field completely, including City, State, and Zip + 4.
In the Financial Institution section, enter the Name on Bank Account, Bank Transit Routing Number, and Bank Account Number. Confirm if this account applies to all sites listed above.
Complete the Supplier Authorization Acknowledgment by signing in the Authorized Signature field. Print your Name and Title clearly below your signature.
Finally, add the Date of completion before submitting your form via email or mail as instructed.

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What is an EFT form used for?

Electronic funds transfers (EFTs) are transactions that move funds electronically between different financial institutions, bank accounts, or individuals. EFTs are frequently referred to as electronic bank transfers, e-checks, or electronic payments.

Who needs to fill out an EFT form?

Completing the Medicare Enrollment Application - Electronic Funds Transfer (EFT) Authorization Agreement (CMS-588) application. The Electronic Funds Transfer (EFT) Authorization Agreement (CMS-588) application is used to have your Medicare payments deposited directly into your bank account.

Who initiates an EFT payment?

EFTs require two parties: the person or entity sending money and the person or entity receiving the money. The sender initiates the transfer over the internet or at a payment terminal. The transfer request is sent to the senders bank and then back to the receivers bank.

What is an EFT authorization form?

Organizations choosing to pay by EFT must submit an Electronic Funds Transfer Authorization form before EFT payments can be processed. Only a Data Bank administrator can authorize, modify, or terminate your organizations EFT account.

Is EFT safer than mailing a check?

As a kind of EFT, any ACH payment comes with all the same benefits of EFTs generallytheyre faster, cheaper, and safer than using paper checks. More specifically, because ACH payments have to be cleared through an automated clearing house, they include an added level of security validation for those payments.