You may use the red Provider Login button to the left to access the EFT Authorization application and submit your request electronically.
Alternatively, you may click on the link below, print the form, fill it out, sign it with an original signature, and mail it to:
Gainwell Technologies Provider Enrollment Unit
P. O. Box 80159
Baton Rouge, La. 70898-015
EFT for Individual Providers
EFT for Entity/Business Providers