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The standard for payments made by ECHO Health Inc. ("ECHO", “we”, or “us”) is through the Federal Automated Clearing House, commonly known as ACH or direct deposit. ACH is known to be the safest, fastest and most convenient method of payment. To enroll in the ACH payment process, you (as an individual or company) must have a valid checking or savings account at a financial institution that participates in ACH. Most banks and credit unions participate in ACH.
This Agreement is subject to Article 4A of the Uniform Commercial Code (“UCC”). By agreeing to this Agreement and providing us your account information, you agree to provide accurate enrollment information and accept the provisions of this Agreement. Further, you authorize ECHO to credit or debit the account(s) listed on your Enrollment Form (the “Account” or “Accounts”) in connection with processing transactions between you and any Payer(s). You agree to comply with all applicable laws, rules and guidelines related to electronic funds transfers, including without limitation, Article 4A of the UCC and the operating rules and regulations of the National Automated Clearinghouse Association. These rules provide, among other things, that payments made to you are provisional until final settlement is made through a Federal Reserve Bank or payment is otherwise made as provided in Article 4A-403(a) of the UCC. If we do not receive such payment, we are entitled to a refund from you in the amount credited to your Account, and the Payer that originated or instructed such payment will not be considered to have paid the amount so credited. We may also adjust any future payments to you if payments previously made are found to be duplicates, in excess of requirements, fraudulent, in error, or require any other adjustment under the terms of an agreement with you. This may be accomplished using an ACH debit. We may make adjustments to your Account(s) whenever a correction or change is required.
Submission of the ACH Payment Enrollment Form authorizes ECHO to electronically deposit payments through ACH to the financial institution named herein pertaining to payments for health care services rendered. You understand and agree that payments you receive may be from Federal and State funds, and that any falsification, or concealment of a material fact, may be prosecuted under Federal and State laws. Your authorization shall remain in effect until we receive a revised written authorization from you, or your advanced written notice of termination is provided to us. Such notice should afford ECHO and the financial institution named herein reasonable opportunity to act on it. It is your responsibility to provide an updated ACH Payment Enrollment Form to ECHO updating any changes to your financial institution, routing and/or account number(s).
Notice to ECHO should be addressed to:
ECHO Health Inc.
810 Sharon Drive
Westlake, Ohio 44145
ECHO reserves the right to reverse any duplicate or erroneous credit entries.
Consent to Paperless Delivery of Tax-Related
Documents
Please read this information carefully and print or download a copy
for your files.
You may elect to receive tax-related documents from Echo Health Inc.
or its affiliates ("ECHO") via electronic delivery, either via email or
delivered through a web interface where you can go to a website and download the
statement. However, IRS guidelines require that you must first review these disclosures
and provide your affirmative consent to receiving information in an electronic format.
This Consent to Paperless Delivery ("Consent") is effective until affirmatively
withdrawn by you. This is your copy of the Consent.
By agreeing to accept required tax–related documents electronically,
you also agree that:
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Your computer system meets the hardware and software requirements stated
below under "System Requirements"; and
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You will promptly notify ECHO of any change in your e-mail address by
providing your taxpayer identification number and name as it appears on your Form
W-9, either by calling ECHO at (440) 835-3511, or by writing to:
ECHO Health Inc.
810 Sharon Drive
Westlake, Ohio 44145
Consent to Paperless Delivery of Tax-Related Documents
By clicking on the "I have read the Consent and consent to paperless
delivery" checkbox, you acknowledge that: (1) you have read and understand
this Consent; and (2) you affirmatively consent to receive and acknowledge that
you can access, receive, print and retain your tax-related documents (including
IRS Form 1099) electronically. You agree that such information may be communicated
online by posting notices, disclosures, and other communications on our website
or by sending such information to you by e-mail. Your consent to receive tax-related
documents electronically will be effective until affirmatively withdrawn (see "Withdrawal
of Consent"). If you do not specifically consent to the electronic delivery
of tax-related documents by clicking the applicable checkbox, you will continue
to receive paper copies of all required tax-related documents, including Form 1099.
Additional Paper Copies
In addition to consenting to and obtaining electronic copies, you may
request additional paper copies of your tax-related documents by contacting ECHO
as provided above. Requesting a paper copy of your tax-related documents will not
be considered a withdrawal of your consent for paperless delivery. You must formally
withdraw consent to begin regularly receiving a paper copy of your future tax-related
documents.
Notification of Change to E-mail Address
You agree to notify us promptly if your e-mail address or other account
information changes by contacting us as provided above. For information that is
required by law to be sent to you, including Form 1099, if we receive an electronic
notice that an e-mail is undeliverable due to an incorrect or inoperable e-mail
address, we will resend such information via U.S. Postal Service.
Withdrawal of Consent
Withdrawal of consent to paperless delivery is prospective only. Any
withdrawal ensures that future tax-related documents will be delivered to you as
a paper document, but does not apply to any document that has already been furnished
to you electronically. You may withdraw your Consent to paperless delivery by providing
written notice either: (1) by mail at the address set forth above; or (2) by email
to [email protected]. In each case, state that you are withdrawing consent
to paperless delivery of tax-related documents, and provide the taxpayer identification
number and the name as it appears on Form W-9. ECHO may take up to ten (10) business
days after receipt to process your request. You will receive written notice that
ECHO has received and processed your request.
System Requirements
To access your electronic tax-related documents, you need to be able
to read Adobe PDF files. To do this, you must have Adobe Acrobat Reader installed
on your computer. It can be downloaded for free at http://get.adobe.com/reader/.
You also need to have a computer with Internet access that supports the use of a
browser that supports 128-bit encryption, and will need to have JavaScript enabled
in your browser. You need hardware as necessary to support this software. In order
to keep copies for your records, you will need to have access to a printer or have
the ability to download information.
Agreement
You understand and intend that your clicking on the "I have read
the Consent and consent to paperless delivery" checkbox shall operate as your
signature and you acknowledge that you have read the Consent and have printed or
downloaded a copy for your records. You further acknowledge that you affirmatively
consent to receive your tax-related documents, including IRS Form 1099, electronically.
Tax-related documents will remain available electronically for at least one (1)
year after the date the document is first made available to you electronically.
Notice of termination
ECHO reserves the right to stop paperless delivery of your tax-related
documents at any time by giving you notice. If ECHO does so, ECHO will send you
paper copies of your tax-related documents.
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