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P.O. Box 4884 Houston, TX 772104884 8005527879 Fax: 2813687148 Request for Electronic Funds Transfer Note: This form allows your financial institution to pay the premiums for you automatically. As.

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How to fill out the 8005527879 online

This guide provides step-by-step instructions on how to complete the 8005527879 form for requesting electronic funds transfer. Following these clear guidelines will help ensure that you submit your information accurately and efficiently.

Follow the steps to successfully complete the 8005527879 form online.

  1. Press the ‘Get Form’ button to access the 8005527879 form in the online editor.
  2. Begin filling out the form by entering the depositor’s name if it is different from the insured or policyowner. Ensure that if this is a company account, the name of the account is included.
  3. In the next field, provide the name of the financial institution where the funds will be withdrawn from.
  4. Enter your account number, ensuring that the information is accurate to avoid any discrepancies.
  5. Indicate the type of account by selecting either 'Checking' or 'Savings'.
  6. Specify the withdrawal timing by selecting 'Withdraw on the due date of my policy' or providing a specific date for the withdrawal (from the 1st through the 28th of the month).
  7. Next, fill in the policy owner's name, ensuring it is clearly legible.
  8. Provide a phone number where you can be reached for any follow-up communication.
  9. Input the routing number for your financial institution to ensure correct processing of withdrawals.
  10. Enter the policy owner's address, including street, city, state, and zip code. If this is a new address, check the designated box.
  11. Select the frequency of the withdrawal from your account: Monthly, Quarterly, Semi-annually, or Annually.
  12. Type in the insured's name and ensure it matches the information provided on the account.
  13. Sign in the designated area using the authorized signature as it appears on your account.
  14. Finally, enter your policy number and today's date to complete the form.
  15. Ensure you save your changes, download the form if needed, print a copy, or share it as required. Also, remember to send this completed form along with a voided check to the specified address.

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800-552-7879 www.neweralife.com. POLISH FALCONS OF AMERICA. 800-535-2071...
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American Fidelity. (800-325-3748). AFLAC. (800-992-3522). Conseco Life. (800-541-1225)...
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New Era is a leader in providing Medicare Supplement Insurance to customers at affordable and stable premium rates. Normally, you must be enrolled in Medicare Part A and Part B.

Payer Name: New Era Life Insurance Company|Payer ID: 75281|Professional (CMS 1500)

Philadelphia American is a subsidiary of the larger New Era Life Insurance Company. New Era specializes in health insurance and also offers Medicare Supplement insurance. Their offices are located in Houston, Texas. They offer Medicare Supplement insurance all over the United States.

New Era Life Insurance Companies has a family of companies that offer several different products. One of those companies is Philadelphia American Life, which offers a Medicare Supplement product.

If you have any questions please call our Customer Service Department at 800-552-7879 extension 1331.

New Era Medicare Advantage Plans These health care plans combine your Medicare Part A and Medicare Part B benefits into one plan with little to no monthly premium, most of the time.

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© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Your Privacy Choices
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
altaFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2026
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232