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AUTOGRAFT AUTHORIZATION MOUNTAIN HEALTH NETWORK Phone: 3046964REC (4732) www.marshall.edu/campusrecPERSONAL INFORMATION (PLEASE PRINT): *HOSPITAL ID BADGE MUST BE SHOWN FOR ELIGIBILITY. HOSPITAL ID
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How to fill out auto-draft authorization mountain health

01
Obtain the auto-draft authorization form from Mountain Health.
02
Fill out your personal information including name, address, phone number, and email.
03
Provide your bank account information including routing number and account number.
04
Sign and date the form to authorize Mountain Health to automatically draft payments from your bank account.

Who needs auto-draft authorization mountain health?

01
Individuals who want to make automatic payments for services provided by Mountain Health.
02
Patients who prefer the convenience of not having to manually make payments each time.
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Auto-draft authorization mountain health allows the company to automatically withdraw payments from the individual's bank account.
Individuals who wish to make payments for their mountain health services through automatic bank withdrawals are required to file auto-draft authorization.
To fill out auto-draft authorization mountain health, individuals need to provide their bank account details, authorize the company to make automatic withdrawals, and sign the authorization form.
The purpose of auto-draft authorization mountain health is to simplify the payment process for individuals receiving mountain health services and ensure timely payments.
The information to be reported on auto-draft authorization mountain health includes bank account number, routing number, authorization for automatic withdrawals, and signature of the individual.
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