EFT Authorization

By clicking the “Accept” button below, I authorize Arbella Mutual Insurance Company, or its affiliates, to initiate monthly premium payments by withdrawals from my bank account at the financial institution identified above in the amount of my current monthly premium. I also authorize the above financial institution to accept such withdrawal instructions and debit my bank account and understand changes to my policy may change the amount debited. This authorization is effective as of the date hereof and will remain in effect until I provide written, electronic or telephone instructions to terminate such authorization to Arbella within a reasonable time in order to allow Arbella to terminate such authorization.

Authorized Electronic Signature

By clicking “Accept” below I represent that I am the owner and/or authorized signer on the bank account identified above, I am agreeing to the terms and conditions of the above EFT Authorization and I am entering into a legally binding electronic agreement and consenting to the use of my electronic signature.