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
F&G Service Center
P.O. Box 81497
Lincoln, NE 68501-1497
Overnight mail
F&G 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
F&G 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]
Download ADMIN577822-0084