To apply for ADA Income Protection coverage, simply download and print this application. Your completed application can be faxed to Great-West Life at 303-737-4843 or mailed to us at P.O. Box 340, Denver CO 80201. If you have questions while completing your application, contact Great-West Life at 866-607-5338 or ada@gwl.com.
When you click on the button below, please be patient while the application is retrieved. Because the file is large, it may take several minutes to download.
Application
Adobe Acrobat Reader is required to view this document.
Download
a free copy of Acrobat Reader.