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Electronic Check Payment


Disclaimer: There is no charge to process your check payment.  Once you process this payment, please void this check # from your registry

First Name
Required
Last Name
Required
ZIP / Postal Code
Required
E-Mail Address
Required
Check Number # (As it appears on your check)
Required
Company Name (As it appears on your check)
Required
Address (As it appears on your check)
Required
City, State and Zip (As it appears on your check)
Required
Name of your Banking Institution
Required
Amount of your Payment/Check
Required
Bank Routing Number
Required
Checking Account Number
Required
I Authorize Preferred American Insurance Services as signatory agent for my check number and amount listed above in United States Dollars.
Required


Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.