Request For Automatic Withdrawl

Please enter your information here and we will send you the electronic funds transfer (EFT) form electronically. It will come from a website called Docusign.

  1. The email will be from Insurance Services by Docusign
  2. Open the email and click the yellow box the says "View Document"
  3. The webpage will prompt you for your Routing & Account number as well as a signature.
  4. After entering all the information, click finish and it will send it back to our office and we will take it from there.

Any Questions, call us at 419-663-1220.