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Get Allstate Insurance Card Template

To draw drafts on I hereby agree that the presentation of such drafts shall constitute due notice of premiums being due on this policy. against my checking account with the (Day of Month) Dated at: (Name of Bank) Mo./Day/Yr. of (Address of Bank) to pay premiums for insurance on the life of (Bank Account Number) X (Signature as it appears on signature card at Bank) issued under Policy No. Please Sign Top & Bottom of this Form and Attach Sample Voided Check from this Account Authorizat.

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