Electronic Funds Transfer
Download the Electronic Funds Transfer Request form and follow the steps to have your premium or loan payment automatically withdrawn from your bank account.
Electronic Funds Transfer
Download the Electronic Funds Transfer Request form and follow the steps to have your premium or loan payment automatically withdrawn from your bank account.
Printing and completing the form:
1
Open the form after downloading from above
You will need the free Adobe Acrobat Reader to view and print it.
2
Fill out the section appropriate to your change
3
Print the form and sign it
4
Fax the form along with a voided check to 608.443.5052.
Or mail the form and a voided check to us at: 123 Town Square Place PMB
749 Jersey City, NJ 07310.
Note: When you close the Acrobat Reader, your entries will not be saved. If you print the form and realize you need to add or change something, your entries will still be there as long as you did not close the program.
If you have any questions, please feel free to call us toll free 800.548.2962.
In order to have premium payments withdrawn from your bank account, the policy must be paid current.