Garity EFT Form

GarityAdvantage EFT Form

NOTE: Form is secured by encryption feature
This is a:
Agent Name:

First NameLast Name
Agent Social Security #
xxx-xx-xxxx
Email Address
I hereby (1) authorize Garity Advantage Agencies, Inc. and its corporate affiliates to make payments for Payee’s services by Electronic Fund Transfer (EFT), (2) certifies that the Payee has selected the following depository institution, and (3) directs that all such EFTs be made as provided in this form:
Make All Commissions Payable by Electronic Funds Transfer to:
Name of Entity
TIN#
Bank Routing #
9 digits- lower left corner of check
Bank Account #
Do not include check #
Bank Name
Account Type:
New submissions must also include a completed W9 form.
Download a fillable W9 form here.
Upload your completed W9

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Date Requested

MonthDayYear
Date
Signature
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GarityAdvantage EFT Form