EFT Enrollment Instructions

Electronic Funds Transfer Enrollment Instructions

 

What is Electronic Funds Transfer or EFT?

EFT stands for “Electronic Funds Transfer” and it is the automatic deposit of payment into your account at a designated financial institution.

Who is eligible?

Any Patient Advocate Foundation patient being served by the Co-Pay Relief program and providers, including physician offices and pharmacies, that are providing medical care and/or pharmaceuticals to a CPR patient. The patients and providers must have an open banking account to which EFT’s can be directed.

How do I sign up?

Complete the information on the “ELECTRONIC FUNDS TRANSFER (EFT) ENROLLMENT FORM”, attach required documentation and return to Patient Advocate Foundation, Attention: Accounting Department via a secured fax at (757) 952-2039.

How long does it take before I will start receiving deposits via EFT?

As soon as we receive the EFT enrollment information, all future payment requests can be made via EFT. You will be notified via email of your selection to use EFT and the confirmation of the EFT set up for future payments.

If I have any questions about EFT who do I call?

A. Contact PAF Accounting Department 1-800-532-5274 x1256 if you have any questions or need any assistance.

 

Download Enrollment Form

DOWNLOAD EFT ENROLLMENT FORM

 


Please mail your completed form to:

Patient Advocate Foundation
Co-Pay Relief Program
421 Butler Farm Road
Hampton, VA 23666


(866) 512-3861 - Toll Free
(757) 952-2039 - Accounting Fax