DIRECT DEBIT PROGRAM
Save time and money!
Make your payments electronically. No more hand written
checks, no more late fees. Direct debit your checking
account, your savings account or your credit card with
an electronic funds transfer (EFT)! To apply, follow
these easy steps:
- Download the Direct
Debit Authorization Agreement.
- Print and complete the form with your name, bank
or credit card information and signature.
- Provide your checking account, savings account or
credit card information. If using a checking account,
please enclose a blank check from your current checking
account and mark this check "VOID”.
- Mail to the address indicated below or fax to 1-800-682-0817.
Note: Please, do not return the Direct
Debit Authorization Agreement with your payment.
We will mail you a schedule of payments indicating
each installment amount, due date, and when the funds
will be automatically withdrawn from your checking account,
your savings account or your credit card. In the event
you make changes to your policy that increase or decrease
your payment, we will mail you a new schedule to reflect
Bristol West Insurance Group
Accounts Receivable Department
P.O. BOX 22-9080
Hollywood, FL 33022-9080
Or Fax to: