CHANGE MY BANK ACCOUNT

Auto and home insurance

Use this form to submit your request securely.

IMPORTANT

Use this form to change the bank account you use to pay for your home or auto insurance.

Changes will not be made to scheduled withdrawals for the next five business days.

If your request concerns a scheduled withdrawal in the next five business days, please contact us at 1-877-700-7778.

First name

Last name

Email address

Date of birth

mm-dd-yyyy

The change of bank account applies to which insurance policies?

My auto policy

Policy number Contains between 8 and 11 characters

My home insurance

Policy number Contains between 8 and 11 characters

My leisure vehicle and RV insurance

Policy number Contains between 8 and 11 characters

First name

Last name

Co-holder (joint account) or agent of the bank account (optional) (optional)

First name

Last name

1- Transit/branch no.

2- Institution no.

3- Account no.

Do you also want to change the date of the preauthorized withdrawals?

Yes

The date on which future payments will be made

Date you would like the change to take effect

mm-dd-yyyy

Maximum of 5,000 characters

Character count:

I confirm that I am the owner of the above-mentioned policy(ies) and am authorized to make this request.

I understand that the requested change(s) will take effect when I receive confirmation by email or by telephone.