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Electronic fund transfer enrollment form 1 10/2006. Web of the approved electronic funds transfer (eft) authorization agreement form. Cobra/portability payments, 221 dawson road, columbia, sc 29224. Changes to existing banking information will trigger a new 10 to 15 day pre‐note period. Web completed new or change authorization agreement forms with voided check and/or bank letter and completed cancellation authorization agreement.
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2) review the document and fill out all required fields. Web advice (era) and electronic funds transfer (eft) authorization agreement. New request change to existing eft authorization 1. Web use this form 1) to enroll in both era and eft; Changes to existing banking information will trigger a new 10 to 15 day pre‐note period.
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Changes To Existing Banking Information Will Trigger A New 10 To 15 Day Pre‐Note Period.
Type of request select appropriate company(ies) and indicate type of request the selected aetna inc. 2) review the document and fill out all required fields. Electronic fund transfer enrollment form 1 10/2006. Web access all aetna era documents online at:
Or 3) To Change Both Your Era Vendor And Your Bank Account.
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