Surepay online 2025

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 the applicant differs from the person being billed, fill in their name and Blue Cross Blue Shield of Arizona ID number in the designated area.
6. Ensure you read through the authorization statement carefully. Sign and date at the bottom of the form to confirm your agreement.
7. Once completed, save your changes and send it via mail or fax to Enrollment Services at Blue Cross Blue Shield of Arizona.

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