Merit Multi-Payment Transmittal
Used to list multiple account payments to be sent with one broker payment. Please use additional form if needed.
Insurance Brokerage Name
Merit Broker Code
Enter Payments Received
Rows
Name
Merit Account
Amount
Method/Info
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Total Payments on this Report
Sender's Email
*
agent@insurancebroker.ca
Transfer Monies
Please Select
Sending by Mail/ ICS
Request Merit withdraw amount
Sending monies on EFT to Merit
Date
-
Month
-
Day
Year
Date Sending Payments/ Deposit Date
Bank Reference Number
Any reference number
Upload copy of any supporting documentation
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Enter Bank Account Information for Withdrawal of Specific Total Amount on Date
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