Instructions for Completing the Direct Deposit Form

INSTRUCTIONS FOR COMPLETING THE DIRECT DEPOSIT FORM

Enrollment Form: Direct Deposit of Payments

If you would like to receive payments electronically, please complete the Enrollment Form. The form is simple to complete. Please follow these steps:

Company Name & Address: Indicate in this line the legal name of the company, followed by the full address and contact person.
Authorized Account Signer and Date: Staff member in your company that has authorization to sign checks and release funds on the account.
JointAccount Signer and Date:Same as above
Financial Institution Name: The full name of the bank you use to conduct business.
Financial Institution Routing Number (also known as ABA number): This is the nine digit number found on the bottom left corner of the check.
Customer Account Number: This is the printed numbers that appears on the left bottom corner of the check directly after the Routing Number.
Attached Scanned Voided Check Here: Please attach a scanned voided check where so indicated on the form. This information is used by the bank to set up a bank account to receive electronic deposits.

FREQUENTLY ASKED QUESTIONS

Question: How will I know when my contracts funds have been transferred to my bank account?

Answer: Your bank will notify you of the arrival of Public Health Solutions (PHS) funds. Most banks will identify the sender as well as the date and amount of the transfer. It may take your bank a day or two to send you notification unless you have online access to your account.

Question: What if I have more than once contract with Public Health Solutions – how will I know which invoice is being paid?

Answer: Unless the amount we paid is exactly the same as the amount you invoiced (in which case you could simply reference the invoice you sent us), you will need to wait until you receive the Direct Deposit check stub and back-up documentation from Public Health Solutions.

Question: What if Public Health Solutionsstaff tell me my funds have been transferred but my bank does not record a deposit?

Answer: Contact yourPublic Health Solutions Contract Manager right away.

Question: Can I decide at a future point to participate or withdraw from Direct Deposit?

Answer: Yes. You will need to complete a Direct Deposit Enrollment or Dis-enrollment Form.

Question: Can Public Health Solutionsnotify me when it has transferred my funds to my account?

Answer: This will not be automatic but your Public Health Solutions Contract Manager will be able to tell you if funds have been transferred, so you can check with your bank.

Question: When should I expect an electronic payment?

Answer: This will be no different from the paper checks you receive now. Public Health Solutions processes monthly invoices within 60 days of receipt. Electronic payments, like paper checks, are transmitted on Friday. That means funds should be in your account by Monday, and will be available immediately.

Question: When can I expect Direct Deposit to begin?

Answer: Your Direct Deposit will begin within 30 days from the date we receive your request.

Question: Whom may I contact for further information?

Answer: Contactyour Public Health Solutions Contract Manager.