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Signature of Account Holder Date / USAA LIFE INSURANCE COMPANY 9800 Fredericksburg Road San Antonio Texas 78288 For inquiries call us at 1-800-531-8722 34559-0611 LLL444ST. I acknowledge that the origination of Automated Clearing House ACH transactions to my account must comply with U.S. Law. USAA Number Contract Number Both USAA Life Insurance Company and USAA Life Insurance Company of New York are referred to as USAA Life in this form. 1. I hereby authorize USAA Life to make electronic...
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