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General Forms


Use this form to...


Application for Change of Address

Request change of address for certificates and/or payer

Must be signed by the insured and payer/owner

Electronic Forms Transfer (EFT) Authorization

Authorize electronic funds transfer to pay your life premiums, annuity deposits, or mortgage payment to WSA

Include a voided blank check or deposit slip showing your pre-printed routing transit number and bank codes

2021 Board of Directors Election Ballot

Cast your vote for WSA's Board of Directors

Ballots must be received by June 15, 2021




11265 Decatur St.

Suite 100

Westminster, CO 80234




PO Box 351920

Westminster, CO 80035-1920




(800) 451-7528

(303) 451-1494


(303) 451-5112




WSA Fraternal Life is not licensed in all states. Nothing contained herein should be construed as a solicitation for insurance or annuity products in any state in which WSA Fraternal Life is not licensed.

Click here for a compete list of states in which WSA Fraternal Life is licensed.

Participation in any WSA Fraternal Life event constitutes agreement to the Terms and Conditions for Participation in WSA Events

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