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Medicare & Senior Support
Direct Deposit Enrollment Form
The Agency That Does More For You
Please fill in the information below to enroll in our Direct Deposit program.
Email address for EFT notifications.
Select Companies for Direct Deposit
Select Checking or Savings
Enter your account #
Enter your routing/transit #
Check this box to grant authorization.
I hereby authorize PGP to initiate deposits to the account described above. This authority will remain in force and effect until PGP has received written notification of discontinuation and in such manner as to afford PGP a reasonable opportunity to act on it.