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MONTHLY RECURRING CREDIT CARD AUTHORIZATION FORM MetLife Auto Home Yes I want to pay my MetLife Auto Home premiums through automatic monthly billing to the designated credit card. 00. I must give MetLife Auto Home 25 days written notice to stop the charges or to change my credit card account information. By completing this form I hereby authorize Metropolitan Property and Casualty Insurance Company and its Affiliates and the credit card company identified on this authorization to future policy I may purchase if I verbally give my consent. Provide credit card information All information in this section is required. Card type Visa MasterCard Discover Print name as it appears on credit card Billing Address of Cardholder Credit Card Account Number Process the charge on or about the 5th 12th American Express 19th 28th of the month. Expiration Date BE SURE TO READ AND SIGN THE AGREEMENT AND MAKE A COPY OF THIS FORM FOR YOUR RECORDS. 3. Sign I understand that MetLife Auto Home will notify me in advance of any changes to the charged amount of more than 1. If the premium is to be charged to a third party credit card account the accountholder must complete and sign below I agree to pay the monthly premiums for the above referenced policy on behalf of the named insured and hereby authorize Metropolitan Property and Casualty Insurance Company and its Affiliates and the credit card company identified on this authorization to process the charges authorized herein. I understand that any changes to the policy that may affect the charge amount will be communicated to the insured only. If your policy is serviced by an Independent Agent mail to METLIFE AUTO HOME ATTENTION PROCESSING UNIT P. 1. Select the policy ies you want billed to your credit card and provide us with the policy number s For Packaged Policy COMBO or GrandProtect Account Number For Individual Policy ies Automobile Home Other specify OR PELP Boat Please note - PAK II policies are not eligible for the Monthly Recurring Credit Card pay plan* - A 2. 00 processing fee may apply to each monthly bill* - Policies that are currently being billed to your mortgage company will not be transferred* 2. Provide credit card information All information in this section is required* Card type Visa MasterCard Discover Print name as it appears on credit card Billing Address of Cardholder Credit Card Account Number Process the charge on or about the 5th 12th American Express 19th 28th of the month. Expiration Date BE SURE TO READ AND SIGN THE AGREEMENT AND MAKE A COPY OF THIS FORM FOR YOUR RECORDS* 3. Sign I understand that MetLife Auto Home will notify me in advance of any changes to the charged amount of more than 1. I understand that any refunds on the policy may be applied to the credit card account of the cardholder when the policy is billed to a credit card belonging to someone other than the insured* Policyholder Name Print Policyholder Signature 4. If the premium is to be charged to a third party credit card account the accountholder must complete and sign below I agree to pay the monthly premiums for the above referenced policy on behalf of the named insured and hereby authorize Metropolitan Property and Casualty Insurance Company and its Affiliates and the credit card company identified on this authorization to process the charges authorized herein* I understand that any changes to the policy that may affect the charge amount will be communicated to the insured only. .
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