*Refer to agent's manual for down payment requirements. WEST BEND MUTUAL INSURANCE COMPANY. 1900 South 18th Avenue • West Bend, WI 53095 • thesilverlining.
*Refer to agent's manual for down payment requirements. WEST BEND MUTUAL INSURANCE COMPANY 1900 South 18th Avenue • West Bend, WI 53095 • thesilverlining.com Authorized signature Routing Transit # Account # Check # Memo Check # Routing Transit # Account # Memo APPLICANT INFORMATION Customer Number/Policy Number Name of Applicant Agency ...
22 июн. 2021 г. — n I would like to take advantage of the EFT Program. I understand payments will be withdrawn from my account when due. Withdrawals that cannot be made could ...
Insured EFT Authorization Form Eliminate the hassle and expense of making your West Bend insurance payments! Use our Electronic Funds Transfer (EFT) Program. Here's how: 1. Upon your approval, we'll divide your annual premium into installments and withdraw that amount directly from your designated bank account. 2. A debit of withdrawal notice will be sent 21 days before your due date and for all subsequent premium changes. 3. The EFT program is a fast, easy way to make your West Bend premium payments. To begin using the EFT program, simply complete this authorization form, enclose a voided check, and return it to our office. A $1.00 billing fee per installment will be applied. YES! Sign me up for Electronic Funds Transfer. To begin using the EFT program, complete this authorization and bank account information below and return to our office by email or fax (see below). New Application* Existing Customer Change Bank Information Email:...................................... billing@wbmi.com Billing Personal Lines Fax:............... 262-338-5126 Billing Commercial Lines Fax:......... 262-335-7007 Billing Phone:............................... 800-236-5002 APPLICANT INFORMATION Customer Number/Policy Number Name of Applicant Agency Name of Bank Type of Bank Account Personal: n Checking n Savings Bank Transit Routing Number Business: n Checking n Savings Bank Account Number Memo Examples of where to find your Transit Routing and Account numbers: Memo Routing Transit # Account # Check # Check # Routing Transit # *** INCLUDE A VOIDED BLANK CHECK*** The bank transit routing number and account number are found at the bottom of the check. Do not use the numbers found on the deposit slip as they may not be the same. Account # Please read the following and authorize West Bend Mutual Insurance Company to enroll you in the EFT Program. n I would like to take advantage of the EFT Program. I understand payments will be withdrawn from my account when due. Withdrawals that cannot be made could result in the recall of my EFT privilege. Withdrawals returned by the bank will generate a $25.00 fee and may result in the recall of my EFT privilege. n I give permission to withdraw any current outstanding balance due. n I'd like to review notifications via email about EFT activity. My email address is . SIGNED Authorized signature DATE IMPORTANT: An automatic withdrawal transaction between the bank and West Bend Mutual Insurance Company begins 20 days before the withdrawal date. A withdrawal amount cannot be changed once the transaction has begun. Any endorsements processed during this time will reflect on future withdrawals only. Notice of at least four business days must be given to cancel a scheduled withdrawal. To stop a transaction in less than four business days, the insured must contact their financial institution. *Refer to agent's manual for down payment requirements. WEST BEND MUTUAL INSURANCE COMPANY 1900 South 18th Avenue · West Bend, WI 53095 · thesilverlining.com WB-1899 (1-20)Adobe PDF Library 15.0 Adobe InDesign 15.0 (Macintosh)