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ELECTRONIC FUNDS TRANSFER AUTHORIZATION FORM

4/7/2016

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The information concerning your organization’s financial institution will be used to make electronic fund transfer (EFT)
payments on all claims that are due and approved for payment for the legal business name listed on the form. Please note
that EFT payments can be made only to checking accounts

Contact Information

Customer Service, 1-304-558-7850, 1-888-680-7342, peia.help@wv.gov