Transfer Information Form

* ALL SENSITIVE INFORMATION IS ENCRYPTED FOR YOUR SECURITY AND NOT SHARED WITH ANY OTHER ENTITY.

FORM DESCRIPTION

Form Reason:*

Select the reason for the submission of this form.

First Time Setup
Change of Address – Phone, Email, Website
Change In EFT Contact / Authorized Signer
Change of Bank Information
Change of Checking Billing Dates
Change of Credit Card Billing Dates
Change of Checking & Credit Card Billing Dates

BUSINESS INFORMATION

Business Name (DBA):*

Enter the name of the business.

Business Phone:*

Enter the business telephone number.

Business Website:

Enter the website address of your business.

Contact Name:*

Enter the business contact name.

First Last

Contact Email:*

Enter your email address.

EIN – Tax ID*

Enter the Employer – Tax Id.

Business Address:*

Enter your business address.

Street Address Address Line 2 City State ZIP Code

Business Organization Type:*

Select the business organization type.

CORPORATE INFORMATION

Corporation Name:

Enter the name of your corporation.

Corporate Contact:*

Enter the corporate contact.

First Last

Corp. Contact Title:*

Enter the contact title.

Corp. Contact Email:*

Enter the contact email.

Corporate Address:*

Corporate Address same as Business Address

Street Address Address Line 2 City State ZIP Code

Corporate Phone:

Enter the corporate phone.

Electronic Funds Transfer Information

Step 1 of 4

* ALL SENSITIVE INFORMATION IS ENCRYPTED FOR YOUR SECURITY AND NOT SHARED WITH ANY OTHER ENTITY.

FORM DESCRIPTION

BUSINESS INFORMATION

CORPORATE INFORMATION

BANKING INFORMATION

* NO BANKING INFORMATION CHANGES

BILLING INFORMATION

* NO BILLING INFORMATION CHANGES

PBFE AUTHORIZATION