Surepay online 2026

1. Click ‘Get Form’ to open the Sure Pay Authorization Form in the editor.
2. Begin by entering the 'Person to be Billed' section. Fill in the last name, first name, and initial of the individual responsible for payments.
3. Provide a daytime phone number and complete the address fields including street address, city, state, and zip code.
4. Select whether you would like to debit your checking or savings account by checking the appropriate box. Enter your routing transit number and account number.
5. If applicable, provide information about the applicant if they differ from the person being billed, including their name and Blue Cross Blue Shield of Arizona ID number.
6. Ensure you read through the authorization statement carefully. Finally, sign and date the form at the bottom to authorize automatic withdrawals.

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