Joan Siering  
 
Joan Siering Insurance

 Insurance Specialist
 Since 1983              

 415.648.8700  or  510.550.1604 
 510.601.5079 fax

www.jsins.com

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Pay Your Bill

You can make payments to your policy by using Check-by-Fax.  This allows you to pay with your Check using either fax, email or by completing the form below.  Click here, to get the bank form.  After you complete it, you can then either fax or email it to us. Once you submit the information, make sure to mark your check register and remember not to reuse the same check.

Insureds Name    Policy Number         
Name on Bank Account 
Check #     Amount of Check $
Bank Routing Number   (numbers on bottom of check)
Reconfirm Routing Number 

By submitting this form you agree to the above payment amount, and authorize the deduction from your checking account.   Initial in agreement

I agree by reinitialing , I understand and approve the above transaction.  

Date 
    

 

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All information and images are copyrighted. Revised 07/26/06