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safelite solutions eft payment authorization - SGCNetwork.Com

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UPDATING YOUR BANK REMITTANCE ACCOUNT<br />

This short guide will detail how to best notify Safelite Solutions Network of your company’s<br />

recent or pending change in electronic banking accounts. It is important to make sure that<br />

Safelite Solutions Network knows of this change as soon as possible. Failure to update in a<br />

timely manner can result in your account reverting back to paper checks.<br />

• To update your Safelite Solutions Network account, simply fill out a new EFT<br />

application using the details from the new account. In the section where the form asks if<br />

the action being requested is an ADD/CHANGE/DELETE – please mark this as a<br />

CHANGE.<br />

• Return the document to us along with a cancelled check, written from the new account.<br />

We’ve attached a blank EFT application to this guide.<br />

It may also be obtained by visiting this page from the <strong>SGCNetwork</strong>.com website:<br />

sgcnetwork.com/<strong>eft</strong>_terms.jsp<br />

<strong>Com</strong>pleted documents may be mailed to the address listed on the form, faxed to<br />

614-210-9841 or you can send a scanned copy to <strong>SGCNetwork</strong>Agreement@Safelite.com<br />

Thank you,<br />

-Safelite Solutions Network Team<br />

*Find out more about Electronic Solutions with Safelite Solutions Network!<br />

Enter sgcnetwork.com/news_detail.jsp?newsid=114 in your web browser.


SAFELITE SOLUTIONS EFT PAYMENT AUTHORIZATION<br />

Please Note: EFT is only available to shops that have a signed contract<br />

With the Safelite Solutions Network<br />

By signing this application:<br />

1. I authorize Safelite Solutions to initiate electronic <strong>payment</strong> orders to the business account listed below.<br />

2. I agree to notify Safelite Solutions in writing of any changes to the EFT account, or the closing of this account.<br />

3. I agree to the terms and conditions of the Safelite Solutions EFT program.<br />

<strong>Com</strong>pany Name ___________________________________________ Shop # ____________<br />

Street Address<br />

City/State/Zip<br />

Contact Name<br />

______________________________________________________________<br />

__________________________________ State _______ Zip ____________<br />

___________________________________ Title ______________________<br />

Contact Phone ____________________________ Contact Fax ________________________<br />

E-Mail Address ______________________________________________________________<br />

TYPE OF CHANGE ADD ______ CHANGE ______ DELETE ______<br />

BANKING INFORMATION:<br />

Bank Name ______________________________________________________________<br />

Bank ABA # ____ ____ ____-____ ____ ___- ____ ____ ____ (9-digit Bank Routing/Transit #)<br />

Account Name ______________________________________________________________<br />

Bank A/C # ______________________________________________________________<br />

Please attach a copy of a voided check from this account for verification purposes.<br />

*Signature<br />

*Printed Name<br />

________________________________________ (must be owner or corp. officer)<br />

___________________________________ Federal Tax ID ______________<br />

To apply for Safelite Solutions Network EFT participation, SIGN this completed application, enclose a<br />

voided sample check and email or fax both items to:<br />

<strong>SGCNetwork</strong>Agreement@Safelite.com<br />

Fax: 614-210-9841<br />

Safelite Solutions Network / Attention: Contract Management Dept.<br />

PO Box 182277<br />

Columbus, OH 43218-2277<br />

For Internal Use Only<br />

Shop/Parent # __________________________________________ Vendor # _______________<br />

Authorized By __________________________________________ Date _______________


SAFELITE SOLUTIONS EFT PAYMENT AUTHORIZATION<br />

Please tape a copy of a voided check in the space provided below.<br />

*If you do not have access to checks yet, you may attach a counter check from the bank. This<br />

document should list your routing and account numbers. You may also substitute a letter from the<br />

bank which contains your account information.<br />

<strong>SGCNetwork</strong>Agreement@Safelite.com<br />

Fax: 614-210-9841<br />

Safelite Solutions Network / Attention: Contract Management Dept.<br />

PO Box 182277<br />

Columbus, OH 43218-2277

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