Transcription of Electronic Funds Transfer (EFT) Authorization American ...
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Electronic Funds Transfer (EFT) Authorization American ...
CGFLP01594 120711 American continental insurance CompanyContinental life insurance company ofBrentwood, TennesseeAetna Companies Box 1188 Brentwood, TN 37024 Tel: 800 opt. 7 Fax: 866 1 of 1 Please fill in all appropriate information and sign where necessary. Please print clearly using blue or black ink. If completing electronically, fill in all blue highlighted areas. When complete, print form, sign, and return. Keep a copy of this form for your records. Please check your banking statements for payment activity after signing up for one: New request Change to existing EFT authorization1.
CGFLP01594 120711. American Continental Insurance Company Continental Life Insurance Company of. Brentwood, Tennessee. Aetna Companies. P.O. Box 1188
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