applications will be come effective
on the first of the month following
receipt of the application by
ABA. This website is a summary
of coverage, please review your
certificate for additional details.
dues paying members under age
70, and family (lawful spouses,
under age 70, and dependent children,
under age 18, living at home).
All eligible applicants accepted.
authorize American Benefits Association
or its designated agent to electronically
draft my account for my annual
membership fee. The name of my
bank is listed above for my monthly
membership fee. I instruct my
bank, as identified below, to
honor checks drawn in the name
of American Benefits Association
or its designated agent acting
as the Association's agent-in-fact
as a convenience to me to charge
my account and to pay the Association's
account the amount stated in the
electronic transfer. This authorization
is to remain in effect until revoked
by me in writing and you, my bank,
shall be fully protected in honoring
any such check or electronic debit.
I agree that if your treatment
of each check or electronic debit
is dishonored, whether with or
without cause, the bank shall
be under no liability. I have
agreed to have American Benefits
Association or its designated
agent safeguard this authorization,
along with my voided check, to
you, the bank I have named below.
I understand that if for any reason
a scheduled transfer is rejected
by my bank an additional $5.00
charge will apply.