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Texas Farm Bureau
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AssurancePay® Recurring Payments
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Payments
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AssurancePay
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Setup
Please review the information below. Click the Submit button when you have verified the information captured is correct. If the information below is not correct, please click on the Modify button to revise. Clicking Cancel will terminate your request and return you to the Account Summary screen.
Your bill account is currently being paid by Recurring Payments drawn from your bank account. From this screen you have options to modify your AssurancePay settings, or cancel your Assurance Pay recurring payments.
Submissions must be at least five (5) business days prior to the next draft date as shown on the Recurring Payment Schedule to alter or stop your next draft.
Acknowledge the statement below and click the Submit button to confirm removing Recurring Payments from your policy. Clicking Cancel will terminate your request and return you to the Account Summary screen.
Policy Number
Policy Holder Name
Name on Bank Account
Bank Name
Bank Routing Number
Bank Routing Number
Bank Account Number
Bank Account Number
Type of Account
Requested Draft Day
Modify Request
Opt Out
Modify Information
I understand I am responsible for paying any paper billings I may already have received or receive prior to receiving a recurring payment schedule.
Please accept the conditions.
I understand any pending drafts could be from my current bank if not submitted within 30 days of the next draft date.
Please accept the conditions.
Cancel Request
Submit Request
AssurancePay® Recurring Payments must be setup at least five (5) business days prior to your next due date.
Note: Any billed installments on your account will need to be paid before automatic drafting will begin.
AssurancePay® Recurring Payments change submissions must be made at least five (5) business days prior to your next draft date as shown on the Recurring Payment Schedule to alter or stop your next draft.
Policy Number
Policy Holder Name
Name on Bank Account
Name on the account is required
Name on the account must be between 4 and 60 characters
Bank Routing Number
Routing number is required
Routing number must be between 4 and 60 characters
Routing number format is invalid
Bank Account Number
Account number is required
Account number must be between 4 and 60 characters
Re-enter Bank Account Number
Account number confirmation is required
Account number confirmation must be between 4 and 60 characters
Account numbers do not match
Type of Account
Checking
Savings
Bank account type is required
Requested Draft Day
Requested draft date is required
Requested draft date format is invalid
Cancel
Submit
Confirmation
Your request for AssurancePay® has been submitted.
Once processed, you will receive a Recurring Payment Schedule for your installments.
Please continue to pay any bill statements until you receive your Recurring Payment Schedule.
Thank you for choosing the AssurancePay® Recurring EFT Payment plan.
Your banking information change for AssurancePay® has been submitted.
Thank you for choosing the AssurancePay® Recurring EFT Payment plan.
Your Opt Out of AssurancePay® Recurring Payments has been submitted.
Once processed, you will begin receiving statements for your installments.
Thank you for choosing Texas Farm Bureau Insurance Companies.
Return to Account Summary
If you prefer to use paper instead, please print out and return these documents by mail:
AssurancePay® Enrollment Form
AssurancePay® Change Form
AssurancePay® Opt Out Form