BRISTOL WEST 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:

1. Download the Direct Debit Authorization Agreement.
2. Print and complete the form with your name, bank or credit card information and signature.
3. 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”.
4. 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mail you a schedule of payments indicating each installment amount, due date, and when the funds will be automatically withdrawn from your checking account, your savings account or your credit card.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 these changes.

Mail to:
Bristol West Insurance Group
Accounts Receivable Department
P.O. BOX 22-9080
Hollywood, FL 33022-9080

Or Fax to:
1-800-682-0817