Automatic Bank Debit

The National Guard Association of Mississippi would like to offer you a carefree way to pay your life insurance. With an Automatic Bank Debit (ABD) you can have your insurance paid through your regular checking account, thus saving you time and money. No checks to write, missed due dates, or misplaced bills. You can now have the peace of mind that your life insurance will not be canceled due to non-payment.

If you set up to have your payments made by the ABD method, your checking account will be drafted on the 1^st day of every month. The first draft will start the month after we receive this completed form.

Please also be aware that retiring officers that are not Active Life Members must become a Retired Life Member to maintain coverage. The one time membership may be completed at the following link: https://ngams.org/membership/retired-life-membership/

Please contact Tammy Graves at 601-354-7555 or tgraves@ngams.org with any questions.

Authorization
I authorize the National Guard Association of Mississippi to process a debit against my bank account in payment of my life insurance. Until this authorization is revoked in writing and received by my bank at least 10 working days prior to the scheduled debiting of my account, my bank is authorized to process these debits against my account. In addition, I agree to also notify the National Guard Association of Mississippi in writing if I withdraw this authority.
Name*
First Middle Last Suffix
Contact Number*
Email Address*
Last Four Digits of Social Security Number*
Bank Routing Number*
Bank Account Number*
Effective Date to Begin Draft (Month/Year)*
Please list the month after your military service ends. Your last month of military service is the month you last receive a military paycheck.
Signature*
Please sign with your mouse, trackpad, or touch screen to authorize payments.
Comments
This field is for validation purposes and should be left unchanged.

Automatic Bank Debit

Authorization