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Policy/Payor Details

Credit Card Information

By clicking accept, you the cardholder, authorize Great Western Insurance Company to charge your credit card for insurance premiums, in the amount and frequency listed on the insurance application for the insured listed above.

Agent Use Only

By typing in your agent number and clicking accept, you, the agent listed on the application, attest that you personally verified the cardholder's identification and witnessed the cardholder type his or her name and click accept.