Pay by E-Check with Fudge Insurance

Policy Number*

Name on Account*

Address as it Appears on Your Check*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Bank Name*

Bank Account Number*

Routing Number*

Check Number

Your Account and Routing Numbers can be found on a check issued by your bank.
Please see the example below.

Confirmation Email*

Amount of Payment*

Supporting Documents (If Applicable)

Drop files here or

For Payments by Electronic Check
Pursuant to and as required by Regulation E of the Electronic FundsTransfer Act:

You certify that the account indicated on the billing and payment screen is owned by you and that the funds in such account are sufficient to satisfy the total amount of your payment as indicated on the payment confirmation screen
By clicking “Submit Payment” you authorize Fudge Insurance or the appropriate company to charge the designated bank account the amount confirmed in satisfaction of the bills you selected for payment
You acknowledge that either a paper draft will be printed or an electronic fund transfer will occur as a result; that the transaction will be indicated on your bank account, and that no cancelled check will be returned to you by your financial institution
You acknowledge that the origination of ACH transactions involving your account must comply with the provisions of United States Law
You acknowledge that Regulation E of FDIC Law requires that we retain records of your payment for a period of not less than two years. This information is stored on secure servers protected by firewalls and other measures to ensure its protection as indicated in our Privacy and Security Policy.

Your use of this site and the service it provides shall constitute and indicate:*

By submitting this form, you agree to have your account charged for the above amount.

Your acceptance of these terms and conditions.
Your authorization to charge and agreement to pay the total amount confirmed during checkout, subject to and in accordance with the agreement governing the use of the account you selected for payment.
Your agreement to our privacy policy.

Comments

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Pay by E-Check