Pay with a Check

By clicking “Submit”, I agree to the following terms and conditions:

The account information provided will be used solely for the purpose of making a payment towards the insurance policy identified below.
Correct bank routing and account numbers must be provided to ensure insured receives credit for payment. Bank must also debit the account number provided.
Any online payments made after 3:45PM ET, will be credited until the next business day.
Any online payments must be submitted BEFORE 3:45PM ET if policy is scheduled to expire that day, to avoid Legacy Insurance Group from sending notice that will cancel the policy. Legacy Insurance Group reserves the right to retain payment, even if the insured policy is cancelled, if online payment is made AFTER 3:45PM ET.

Checking accounts only. DO NOT use bank official checks, money orders, bill-pay checks, or other certified fund documents.

Name on Policy*
First Last
Policy Number*
Email*
Check Information
Check Name*
Financial Institution
Check Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Check No.*
Date*
Amount*
Bank Routing Number*
Checking Account Number*
Signature [Type Your Name]*

Check Information