Garity EFT Form

GarityAdvantage EFT Form

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

New EFT SubmissionChange to existing EFT on File
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:*

Individual (SS# listed Above)Corporation
Name of Entity*
TIN#*
Bank Routing #*
9 digits- lower left corner of check
Bank Account #*
Do not include check #
Bank Name*
Account Type:*

CheckingSavings
New submissions must also include a completed W9 form.
Download a fillable W9 form here.
Upload your completed W9*

Browse Files

Cancelof
Date Requested*

MonthDayYear
Date
Signature*
Should be Empty:

GarityAdvantage EFT Form