Follow the steps to complete the enrollment form effectively

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Enter your agency or company name in the designated field.
3. Provide your FSC account number(s) to identify your account. This information is crucial for processing your enrollment.
4. Input your billing email address. This will be used for all communication regarding your payments.
5. Select only one payment option: Automatic Debit/eCheck or Credit Card. Ensure that you fully read and understand the terms associated with your choice.
6. If choosing Automatic Debit/eCheck, fill in the required bank information, including the depository name, branch, city, state, and zip code. Fill in your account and routing numbers. Make sure to select whether it’s a checking or savings account.
7. Authorize the automatic debit by providing your name(s) and signature(s) along with the date. Remember to attach a voided check.
8. If opting for Credit Card payment, select your card type and complete the card number, expiration date, CSC number, and cardholder's name, along with billing address and phone number.
9. Include your authorized signature and the date to finalize your authorization for payment.
10. Once complete, save your changes and ensure all information is accurate. You can now download, print, or share the form as needed.

Complete your enrollment process by filling out the Vertafore FSC Payment Enrollment Form online today.