Download and complete the Provider registration for Electronic Funds Transfer payments form.
This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.
You can upload or complete this form online through HPOS. Read more about form upload in HPOS.
If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please contact us. We can help you access, complete and submit them.