Corporate Claims Division

01/24/2019
Corporate Claims Operations
Brady Connolly 301 East 4th St, 19th Floor
10 S. LaSalle St., Suite 900 Cincinnati, OH 45202-4201
Chicago, IL 60603

Dear Brady Connolly:

Great American Insurance Company (including its subsidiaries and affiliates, collectively “Great American
Insurance”) is pleased to offer you the option to join our Electronic Claim Payment program. With this option,
claim payments will be directly deposited into your bank account, as opposed to receiving a paper check.

Advantages of Electronic Payments

 Get paid faster – Funds from electronic payments will be available in your bank account faster than
paper checks
 Safe and secure – Avoid the risk of lost or stolen checks
 Convenient – No more trips to the bank to deposit paper checks

Get Started Now

Begin by completing the “Authorization for Payments by Electronic Fund Transfer (EFT)” form and submitting
the completed form to ePaySupport@gaig.com or by mail to Great American Insurance, Attention: Corporate
Claims Operations, 301 East 4th St, 19th Floor, Cincinnati, OH 45202-4201.

To update your bank account or opt-out of the Electronic Claim Payment program, simply resubmit an updated
“Authorization for Payments by Electronic Fund Transfer (EFT)” form. You may also revoke your authorization
at any time by notifying Great American Insurance by email at ePaySupport@gaig.com. Please note Great
American Insurance requires notice of at least five business days to cancel your authorization.

Sign-up is Easy

After we process your “Authorization for Payments by Electronic Fund Transfer (EFT)” form, the Authorized
Contact will receive a “Great American Insurance Claims ePayment – Go to ePay” email. Click the Go to
ePay button to start the enrollment process.

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Next, you will be asked to verify your identity by entering the last 4 digits of your Social Security Number,
Phone Number, and Zip Code provided in the “Authorization for Payments by Electronic Fund Transfer (EFT)”
form.

For additional protection purposes, you will receive a temporary identification code via Voice (Phone Call) or
Text.

Finally, you will provide your bank account information of the Payee and click the Save button.

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After saving your bank account, you will receive a “Great American Insurance Claims ePayment: Your Bank
Account Has Been Added” email from us.

Each time an electronic claim payment is issued to you, you will receive a “Great American Insurance Claims
ePayment Bank Transfer has been Initiated” email from us.

If you have any questions regarding the Electronic Claim Payment program, please contact us at 877-244-
2176 between 8:00 AM ET and 5:00 PM ET Monday through Friday or email us at ePaySupport@gaig.com.

Sincerely,

ePayment Support Team

Great American Insurance Group
ePaySupport@gaig.com
877-244-2176

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 Corporate Claims Division

CUSTOMER AUTHORIZATION FOR PAYMENTS BY ELECTRONIC FUND TRANSFER (EFT)

Customers must complete this form to receive payments from Great American Insurance Company
(including its subsidiaries and affiliates, collectively “Great American Insurance”) via electronic fund
transfer (EFT). The Authorized Contact is the person authorized by you to enter the bank account
information, to request a bank account information change, or to request to stop receiving EFT payments.

This form requires a handwritten signature by you or an authorized representative of your

company.

Please select one: New EFT Request Change EFT Request Stop EFT Request

Customer Name:

Authorized Contact Name: (If none, write N/A)

Customer Last 4 Digits of SSN:

Claim Number:

Physical Address:

Customer Phone: (Direct Line)

Customer Email:

For security purposes, please complete the following field about you or the Authorized Contact.

This information will be required when you or the Authorized Contact logs into our ePay portal.

Zip Code:

By signing below, I verify the above information is true and correct. I also authorize Great American
Insurance to electronically credit the account provided by myself or the Authorized Contact identified
above, and if necessary, electronically debit the account to correct erroneous credits. I understand that I
may revoke this authorization at any time by notifying Great American Insurance by email at
ePaySupport@gaig.com. Great American Insurance requires notice of at least five business days in
order to cancel this authorization. In the event I cancel direct deposit of claim payments, future claim
payments will be made via paper check.

Signature:

Name (Printed):

Date:

Please submit this completed authorization form by email to ePaySupport@gaig.com, or by mail to Great
American Insurance, Attention: Corporate Claims Operations, 301 East 4th St, 19th Floor, Cincinnati, OH
45202-4201.

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