Enroll

New Customer Information

At Express Funeral Funding, we value every customer like friends and family. This information will allow us to create your customized user profile. We will not disclose this information to any entity not affiliated with Express Funeral Funding.

How did you hear about us? ^*

Please let us know how you heard about EFF

Were you working with a Sales Representative? ^*

Yes

Sales Representative Name

Referral Funeral Home Name

Funeral Home/Cemetery Name ^*

Location Owner or Authorized Individual ^*

First Name ^*

Last Name ^*

Title ^*

What is your job role?

Authorized Funeral Director License ^*

Location Information ^*

Street Address ^*

City ^*

State/Region/Province ^*

Postal / Zip Code ^*

Country ^*

Email ^*

Office Phone Number ^*

- -

Fax Number ^*

- -

Funeral Software/CRM Provider for Express Hub Integrations

Additional Comments/Message

Banking Information

To get your funding immediately, we need your banking information to initiate all transfers.

Preferred Method of Payment ^*

ACH

Check

(ACH or Check)

Direct Deposit Authorization

I (We) hereby authorize Express Funeral Funding, LLC to initiate credit entries to my (our) checking account indicated below at the depository financial institution named below and to credit the same to such account. This includes my (our) authorization to Express Funeral Funding, LLC to reverse any entries made in error.

Bank Depository Name ^*

Branch Address

City ^*

State/Region/Province ^*

Postal / Zip Code ^*

Routing Number ^*

Your bank routing number is a nine-digit code that's based on the U.S. Bank location where your account was opened. It's the first set of numbers printed on the bottom of your checks, on the left side

Account Number ^*

This authorization is to remain in effect until Express Funeral Funding, LLC has received written notification from me (or either of us) of its termination in such time and in such manner as to afford Express Funeral Funding, LLC and Depository a reasonable opportunity to act on it.

Funeral Home/Cemetery ^*

Tax ID ^*

Owner 1 ^*

Full Printed Owner's Name

Owner 1 Signature ^*

Draw your owner's signature inside the box.

Date ^*

MM/dd/yyyy

Owner 2

Full Printed Owner's Name

Owner 2 Signature

Draw your owner's signature inside the box.

Date

MM/dd/yyyy

Proof of routing and account number picture ^*

To ensure account security, please provide one of the following items: VOID Check, Bank Statement, or Electronic picture of Routing and Account number from a banking app.

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Enroll today and join the Express Funeral Funding family!

New Customer Information

At Express Funeral Funding, we value every customer like friends and family. This information will allow us to create your customized user profile. We will not disclose this information to any entity not affiliated with Express Funeral Funding.

Express Hub Sign-Up, Reporting & Communications

The following contacts will receive updates, notifications, and communications through Express Hub and Express Chat.

Banking Information

To get your funding immediately, we need your banking information to initiate all transfers.

Direct Deposit Authorization