Bank Authorization (BA) Form

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This is our Bank Authorization (BA) Form. This form is used to establish or change a bank account to make and/or receive payment for policies and contracts.

Bank Authorization (BA) Form

Before completing this form, please know:

Once you have established a BA account, other policies can be included with this account so that payments can be made to and from the same bank account on the same date.

Download & Print

Bank Authorization (BA) Form

Complete

Using a blue or black ink pen

Submit in 1 of 3 Ways

Email: [email protected]

Fax: 1 (800) 946-1295

or Mail:
Pacific Guardian Life
Attn: Client Relations Department
1440 Kapiolani Blvd.,
Suite 1700
Honolulu, HI 96814