Get Payment Authorization Form - Echelon General Insurance

Filling out the Payment Authorization Form for Echelon General Insurance is a crucial step in managing your insurance payments efficiently. This guide provides clear instructions to help you complete the form accurately and ensure your payments are processed smoothly.

Follow the steps to accurately complete your form.

1. Click ‘Get Form’ button to access the Payment Authorization Form and open it in your preferred editor.
2. Indicate whether this is a new request or a change of existing information by selecting the appropriate option; fill in your policy number.
3. Provide the applicant's full name and postal address in the specified fields to ensure accurate identification.
4. Fill in the brokerage or agency information, including the postal code, contact number(s), and preferred document language (English or French).
5. Input your total estimated policy premium and select your method of payment, which can include single payment or payment plan options.
6. If utilizing a credit card, fill in the section with the card details, including card number, expiry date, and cardholder's signature. Remember to verify which card types are accepted.
7. For bank account payment options, provide the account holder's details and attach a void cheque as required.
8. Specify the down payment amount or full payment amount along with any additional charges to ensure accuracy in billing.
9. Read and agree to the consent and disclosure section, which outlines your understanding of the terms and conditions related to the payment plan.
10. Finally, ensure all required signatures are provided and input the date before saving changes, downloading, printing, or sharing the completed form.

Complete the Payment Authorization Form online today to facilitate your insurance payment process!