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Get Western Reserve Life Pre Authorized Withdrawal Plan Form

, Cedar Rapids, IA 52499-0001 FAX 800-235-4782 As a convenience to me, I request and authorize the Company to obtain payment of amounts becoming due the Company by initiating charges to my account in the form of checks, share drafts or electronic debit entries, and I request and authorize the financial institution named below to accept and honor the same and to charge the same to my account. I understand that I have the right to receive notice of each electronic debit entry that varies in amoun.

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