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Please complete this form and mail or fax it along with your VOID CHECK to the following address Margit Larot West Coast Life Insurance Company Commission Service Department PO Box 193892 San Francisco CA 94119-3892 OR Fax 205 268-1601 Commission Direct Deposit Authorization I authorize West Coast Life Insurance Company to initiate entries to my our account listed below. Financial Institution Name Your Signature Account Number Agent Number Date T...
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