�����

Late �� $20

NSF �� $10

Reinstatement �� $20

• 50% down payment
• One installment is due at a six-month interval

Late �� $20

Installment:

• Direct bill �� $6
• EFT�� $2

NSF �� $10

Reinstatement �� $20

• 25% down payment
• Three equal installments due at quarterly intervals

Late �� $20

Installment:

• Direct bill �� $6
• EFT�� $2

NSF �� $10

Reinstatement �� $20

• 20% down payment
• Nine equal installments due at monthly intervals

Late �� $20

Installment:

• Direct bill �� $6
• EFT�� $2

NSF �� $10

Reinstatement �� $20

• Direct bill only: 20% down payment
• EFT only: one month down payment
• 11 equal installments due at monthly intervals

Late �� $20

Installment:

• Direct bill �� $6
• EFT�� $2

NSF �� $10

Reinstatement �� $20

• No down payment required
• Automatic premium withdrawals with frequency determined by payroll cycle

Payroll vendor may charge an additional fee for reporting on insured’s behalf

NSF �� $25

Reinstatement �� $20

Make an online payment at **

800-573-1187

Enroll in automatic payments by registering at

EFT Authorization Form

Customer’s bank site

����� Insurance Group

PO Box 580045

Charlotte, NC 28258-0045