Direct Deposit Enrollment Form

Please fill in the information below to enroll in our Direct Deposit program.

Name*
First Last
PGP ID#*
Company Name
Email address for EFT notifications.*
Select Companies for Direct Deposit*
- PGP Benefits
- PGP Life
- PGP Energy
Select Checking or Savings*
- Checking
- Savings
Enter your account #*
Enter your routing/transit #*
Authorization*
- 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.

Request a Complimentary Consultation

We’d love to hear from you. Our team welcomes the opportunity to work with all brokers looking to enhance, streamline, and grow their benefits business. Simply fill out the form below and an Employee Benefits Consultant will get back to you.