Automatic Payment Terms and Conditions

• You have authorized us to store the bank account, credit card or debit card information you provided and to automatically charge to that payment method any amount you owe us related to your policy, including premiums, installment fees and returned payment fees. The charge will be made on or shortly after each due date. However, it is your responsibility to continue to make payments when due until your Automatic Payment is activated. 

• If you are entitled to any refund related to your policy, you authorize us to credit your bank account, credit card or debit card.

• If a charge is not honored for any reason:
  • We may resubmit the charge up to the maximum number of times permitted by law. Your bank account, credit card or debit card may assess a fee each time we submit.
    
  • We may cancel Automatic Payment immediately.

• If a regular payment amount changes, we’ll let you know at least 10 days before charging your account. 

• In order to avoid returned payments, you agree to provide us immediately with updated information regarding the account or card used for your Automatic Payment, including any new expiration date on your credit or debit card. 

• You acknowledge that, if your bank, credit card, or debit card company participates in an updater program and unless you opt out of this service with your financial institution, your bank, credit card, or debit card company may provide us with updated cardholder or account holder names, card or bank account numbers and expiration dates, and we will update our files with this information and continue to charge your account. 

• If you’re applying for insurance, our activation of Automatic Payment doesn’t signify approval of your application. 

• You can cancel Automatic Payment at any time by calling Insurance Service at 800.922.8228 (CA), 888.222.0094 (DE, DC, MD, NJ, PA, VA) or 800.207.3618. We may cancel Automatic Payment or change its terms with 21 days’ notice. If either you or we cancel Automatic Payment, you will still be required to pay any amount due. 

• This authorization applies to CSAA Insurance Exchange or its affiliated companies. You should keep this with your other important papers. If you have a change to your account information, or if you did not sign up for Automatic Payment, please call Insurance Service at 800.922.8228 (CA), 888.222.0094 (DE, DC, MD, NJ, PA, VA) or 800.207.3618 anytime. 

 

Signature of account holder being billed

__________________________________________

Please print name (first, middle initial, last)

__________________________________________

Date signed (mm/dd/yyyy)

__________________________________________