Instructions
Authorize electronic drafts easily with this form.
- Complete the financial institution section
Complete this section of the form with the following:- Name of institution
- Type of account
- Routing number
- Account number
- Policy number
- Sign the signature section
Complete the signature section with account holder and policy owner printed name, signature and date. - Submit form
Return the completed forms with any required documentation via postal mail, overnight mail or fax to our service center.
Postal mail
99精品视频 Service Center
P.O. Box 81497
Lincoln, NE 68501-1497
Overnight mail
99精品视频 Service Center
777 Research Drive
Lincoln, NE 68521
Fax
800.281.5777
Allow 3 business days for faxed documents to enter our processing system. - Allow 15 days to process
99精品视频 will process the request within 15 business days of receipt if in good order. - Confirm updates
We will mail a confirmation letter that the request was processed to the owner's address on record.
Pre-Authorized Check (PAC) Authorization Form [ADMIN 5778]
22-0084