Sign and date
the authorization form so our Health Claims Department can continue working on your claim.
Not exact matches
If
so directed by the transition team, you will be required to complete the
form entitled «
Authorization for Release of Personal Information» (attached).
Please call or email us
so that we can send an
authorization form.
If you have not previously elected to receive dividend payments by Direct Deposit but would like to do
so, please complete the Direct Deposit
Authorization Form (available here) or contact Broadridge toll free by dialing 866-804-4314.
Some insurance companies require a phone -
authorization form on file beforehand,
so you might want to ask about this ahead of time.
The other new
form, Automatic Clearing House (ACH) Recurring Payment
Authorization, enables tenants to pay their rent through an automated clearing house (ACH),
so they needn't bother writing a paper check every time their rent is due.