Get Payment Authorization Form

This guide will help you navigate the Payment Authorization Form, ensuring you provide all necessary information accurately. Follow these instructions for a seamless online experience.

Follow the steps to complete your Payment Authorization Form effectively.

1. Click ‘Get Form’ button to obtain the form and open it for filling out.
2. Begin by entering the insurance company name and postal address in the designated fields.
3. Indicate whether this is a new request or a change of existing information by selecting the appropriate option.
4. Fill out your policy number, as well as your full name and postal address in the applicant section.
5. Provide your brokerage or agency information, including contact names and numbers.
6. Select your preferred document language from English or French.
7. Enter the total estimated policy premium, and indicate your method of payment, choosing between a single payment or a payment plan if applicable.
8. Complete the credit card information section by providing the card number, expiry date, and cardholder's signature if different from the authorized signature.
9. For bank account information, fill in the financial institution details, account number, and attach a void cheque.
10. Complete the payment details section, including the down payment amount and installment amount if applicable.
11. Review the consent and disclosure section, ensuring you understand the terms before providing the authorized signatures.
12. Save your changes, and choose to download, print, or share the form as necessary.

Complete your Payment Authorization Form online now for a streamlined payment process.