Authorization Agreement for Accounts Payable Electronic 2026

1. Click ‘Get Form’ to open the Authorization Agreement for Accounts Payable Electronic in the editor.
2. Begin by filling out the Company Information section. Enter your Company Name, Address, City, State, and Zip Code. Ensure that all details are accurate to avoid any processing delays.
3. Provide the Billing Contact Name, Contact Telephone Number, E-Mail Address for Remittance Information, and your Taxpayer Identification Number (TIN). Choose between Employer Identification Number or Social Security Number as applicable.
4. In the Bank Information section, input your Bank Name and address details. Include a Bank Contact name and their phone number. Specify the Type of Account (Checking or Savings) and provide the Account Name, Account Number, and 9-Digit Bank Routing Number. Verify this routing number with your bank to ensure accuracy.
5. Review the EFT Election Information carefully. By signing this section, you authorize Magellan Health, Inc. to initiate credit entries to your specified account. Remember that this authority remains effective until you submit a written cancellation notice.
6. Finally, sign and date the form at the bottom before returning it via fax, email, or U.S. mail as indicated.

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