Transcription of Electronic Funds Transfer Authorization - …
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Electronic Funds Transfer Authorization - …
Online EFT Payment Authorization v. 03-11-2014 1 Electronic Funds Transfer Authorization Terms & Conditions SECTION I ONE TIME EFT WITHDRAWAL On behalf of _____ (insert full name of insured) referred to as the Insured , I authorize _____ (insert agency name) and its affiliates and subsidiaries ( Agency ) to initiate a one-time Electronic Funds Transfer ( EFT ) withdrawal by Continental Casualty Company and its affiliates and subsidiaries ( CNA ) using Automated Clearing House ( ACH ) processing. EFT withdrawal via ACH is the Transfer of Funds from a business account for the purposes of making a payment. For policy number: _____ Insured name: _____ Bank Name Bank Routing Number (9 digits) Bank Account Number For the payment of premium to CNA in the following amount: $_____ I certify that I have provided the Insured s banking account routing number and account number to the Agency.
Online EFT Payment Authorization v. 03-11-2014 2 SECTION II – AUTOMATIC EFT WITHDRAWALS On behalf of _____ (insert full name of insured) referred to as the “Insured”, I authorize
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