ACH Billing Plan

ACH Billing Plan Information | Back to Information on Payments

Fulmont Mutual Insurance Company is pleased to announce our new electronic Automated Clearing House payment program. We will automatically deduct your insurance premium from your account on your due date to eliminate check writing and save mailing costs. If you wish to use this program, please complete the following information and return it to us at least 10 days prior to your premium due date. All information will remain confidential, and only necessary personnel will have access to your information. There will be no service charge for this new electronic Automated Clearing House payment program.

______________________________	_______________________	___________________________	____________
Your name (Please Print)	Your Signature	Policy Number	Today’s Date

______________________________	_______________________	____________________________
Your Bank Transit/ABA #(9 Digits)	Bank Name	Your Account Number

Your 1^st payment will be deducted from your account on the effective date of your policy or due date, whichever occurs last.

Your 2^nd payment will be deducted from your account on the 60^th day after the effective date of your policy.

Your 3^rd payment will be deducted from your account on the 120^th day after the effective date of your policy.

Your 4^th payment will be deducted from your account on the 180^th day after the effective date of your policy.

For endorsements to your policy within the above billing period, please complete this form and return it to us at least 10 days prior to the premium due date. To avoid service charges, it is suggested that you make the necessary arrangements to pay for any endorsements through this program.

SPECIAL REMINDER:

If you are not interested in ACH payments, please note we still offer our regular payment plan which carries a $5.00 service charge added to your 2^nd, 3^rd & 4^th payments, or you may pay your bill in full by the premium due date. Please note the change to our billing notice – if you are using the four payment plan, please keep your bill in a safe place, as you will no longer be receiving a separate billing for each of the payments due.

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