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EFT Form

This document provides instructions for agents of National Western Life Insurance Company to set up electronic funds transfer for commission payments. It includes a form for agents to fill out with their financial institution information and a signature authorizing the company to deposit commissions into their bank account and make corrections if needed.

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Mope SAS
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30 views1 page

EFT Form

This document provides instructions for agents of National Western Life Insurance Company to set up electronic funds transfer for commission payments. It includes a form for agents to fill out with their financial institution information and a signature authorizing the company to deposit commissions into their bank account and make corrections if needed.

Uploaded by

Mope SAS
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

ELECTRONIC FUNDS TRANSFER OF

COMMISSION PAYMENTS

AGENCY FAX (512) 719-8506

Please type or print legibly:

Agent Name_______________________________________________ NWL Agent Number _________________


I am requesting:  EFT for the first time  A change in my existing EFT instructions.

Financial Institution Information


Financial Institution Name ____________________________________ Phone Number _____________________
Financial Institution Address _________________________ City _____________________State ______________
Name on Account __________________________________________
Account Type:  Checking Account  Savings Account  Investment Account
EFT Routing Number________________________________________ Account Number ____________________

PLEASE ATTACH YOUR VOIDED CHECK HERE

(Concerned about mailing a voided check? Cut off your signature line as an added
precaution.)

I hereby request and authorize National Western Life Insurance Company® (NWL) to electronically deposit into my
checking/savings account all commission payments that are payable to me. I authorize NWL to electronically deduct
from my checking/savings account, as a correcting adjustment, any deposits electronically transmitted to my
checking/savings account in error. This authority remains in force until NWL receives written notice from me
terminating this service or changing the account information for this service.
I agree to provide written notice to NWL of any bank/savings account information changes at least three business
days before the next commission payment is due me. I understand that NWL is not responsible for any payments
made prior to its receipt of written change notice. I understand that commission statements are available on the
Agent’s website at [Link].

_______________________________________________________________________________
Agent's Signature Date

NATIONAL WESTERN LIFE INSURANCE COMPANY®


PO Box 209080, Austin, TX 78720-9080 | 10801 N Mopac Expy Bldg 3, Austin, TX 78759-5415
[Link].4.18 [Link] | NWLCommissions@[Link] | 800-760-3434 Ext. 598 | FAX 512-719-8506

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