$3,000 ACCIDENTAL DEATH & DISMEMBERMENT BENEFIT

Online Response Form

Your Information

* Please fill out all required fields

* First Name:

Middle Initial:

* Last Name:

Date of Birth
(mm/dd/yyyy):

Preferred Language:

Contact Information

Home Phone:

Cell Phone:

Address

* Street Address:

*City:

*State/Province:

* Zip/Postal Code:

Other Information

Beneficiary:

Beneficiary Date of Birth
(mm/dd/yyyy):

Relationship:

Number of Child I.D. Kits :

An AIL representative will call on you to deliver your policy, witness your beneficiary designation, register you for the AIL Plus program and provide your Child Safe Kits. AIL has other supplemental insurance benefits that may be available to you and your family.

If you have questions, please call American Income Life Insurance Company at 1-800-495-1213.

The AMERICAN INCOME LIFE Difference

American Income Life Insurance Company (AIL), an international company, is recognized as one of the largest providers of supplemental insurance in North America. Our superior customer service, from initial contact through the life of a policy, sets us apart from the competition.

For over 60 years, our commitment to working families is respected and appreciated by over 20,000 different groups. These groups represent members of associations, credit unions, fraternal organizations, sports and recreation groups, licensed professionals, non-profit organizations and many other types of groups. We specialize in providing exciting and practical benefits for members.

Visit our website to learn more

No cost and supplemental insurance benefits

To Learn More About The American Income Life Benefits Offered Through BLACKHAWK FCU, Please Download The Letter.

Download Group Letter (PDF)

To view the letter, you will need the Adobe Acrobat Reader.