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Automatic Direct Deposit Authorization Agreement (ACH Credits) By completing this document, you authorize Anthem to credit your bank account for the dollar amount of eligible and verified claims submitted

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How to fill out automatic direct deposit authorization

01

Obtain an automatic direct deposit authorization form from your employer or financial institution.

02

Fill out the form completely and accurately. Provide your personal information such as your name, address, and contact details.

03

Enter your bank account details, including the bank name, routing number, and account number.

04

Specify the amount or percentage of your paycheck that you want to be directly deposited into your account.

05

Sign and date the form to certify that the information provided is true and correct.

06

Submit the completed form to your employer or financial institution for processing.

07

Keep a copy of the form for your records.

Who needs automatic direct deposit authorization?

01

Anyone who wishes to have their wages or income directly deposited into their bank account.

02

Employers who offer direct deposit as a payment option to their employees.

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What is automatic direct deposit authorization?

Automatic direct deposit authorization is a process where an individual authorizes their employer or financial institution to deposit their paycheck directly into their bank account on a recurring basis.

Who is required to file automatic direct deposit authorization?

Individuals who want their paychecks deposited directly into their bank account are required to file automatic direct deposit authorization with their employer or financial institution.

How to fill out automatic direct deposit authorization?

To fill out automatic direct deposit authorization, individuals need to provide their bank account information, such as account number and routing number, to their employer or financial institution.

What is the purpose of automatic direct deposit authorization?

The purpose of automatic direct deposit authorization is to provide a convenient and efficient way for individuals to receive their paychecks without the need for physical checks or manual cashing.

What information must be reported on automatic direct deposit authorization?

On automatic direct deposit authorization, individuals must report their bank account number, routing number, and other relevant banking information.

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