Colo ACH


Colonial Change of Service Request Form Instructions


Effective January 1, 2018 your valuable current Colonial policies will no longer be payroll deducted and need to be set up on bank draft.

The majority of these policies include disability (monthly income) which is paid to you if you are injured on or off-the-job and continue working light duty.

To keep your current policies, please do the following:

1. Gather your policy number(s) by calling Colonial home office at 800-325-4368 or email your agent to retrieve your policy number.


2. Click the button below to electronically fill out the form needed to change your payment method. Complete Section 1, Section 4 and Section 10 and submit to process your request. Your benefits and premiums will remain the same.

3. Upon completion of the form, click the "DONE" button in the upper right corner of the page to submit.

 

PLEASE COMPLETE THE FORM AND WHEN FINISHED, PRESS "DONE" AT THE TOP OF THE FORM

DO NOT FAX

For more information or to retrieve your policy number, please contact your insurance agent(s):

Jennifer Gerdes
Jennifergerdes@coloach.com
(303)791-7771

Shari Fetrow
Sharifetrow@coloach.com
(303)688-5922
Karen Koch
Karenkoch@coloach.com
(303)791-7771