YOUR COMPANY NAME COMMERCIAL ACCOUNT
1234 ELM STREET
YOUR CITY IA 55555-5555 Minimum Due: $2,410.09
Payment is due by MAY 24, 2015
Account: 0X00000
Invoice: A-56240052
Thank you for choosing EMC Insurance Companies to Date: 05/04/15
protect your business.
Your Agent:
Please pay the minimum amount due by the due date to XYZ INSURANCE AGENCY
make sure coverage is available should you need it. 555-555-5555
Refer to the back for more billing information. Contact your agent for policy changes, answers
to coverage questions or to report a claim. You
can also report a claim by calling 888-362-2255,
available 24/7.
Three Easy Ways to Report Claims Register for Policyholder Access on www.emcins.com
Use one of these methods to promptly report your to manage your billing. Sign up for paperless billing
claim: notices, schedule future payments and request billing
- Call 888-362-2255 (available 24/7) reminders.
- Report online: www.emcins.com*
- Contact your agent or local EMC claim office
*Available to most policyholders
YOUR PAYMENT OPTIONS
Electronic Funds Transfer (EFT) Online at www.emcins.com
-Recurring automatic bank account withdrawals -eCheck: Single bank account withdrawal
-No monthly installment fee -Credit/Debit Card: Single payment
Mail (do not send cash) Phone: 855-404-9076 (automated service only)
-Check -eCheck
-Money order -Credit/Debit Card
-Cashier's check
Allow at least 7 days for your payment to reach our office. Include the bottom portion of this invoice with your payment.
Short on time? Pay online at www.emcins.com or call 855-404-9076.
COMMERCIAL ACCOUNT Account Balance: $26,460.91
Minimum Due: $2,410.09
Account: 0X00000 Date Due: 05/24/15
Invoice: A-56240052
Date: 05/04/15
Amount Enclosed:
Check here and complete form on back for address change.
YOUR COMPANY NAME
1234 ELM STREET EMC INSURANCE COMPANIES
YOUR CITY IA 55555-5555 PO BOX 219225
KANSAS CITY MO 64121-9225
00021415206000001517531562400520000264609100002410098
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IMPORTANT BILLING INFORMATION
FEES
Whenever payments are made in installments, a transaction fee is charged. To avoid this fee, sign up for Electronic Funds
Transfer (EFT), which will automatically withdraw the monthly premium from your bank account each time a payment is due.
RETURNED PAYMENT
If payment is returned to us by your bank, we may add a returned payment fee of $25.00 to your account. (Fee amount may
vary based on state law.)
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LATE FEE
If your payment is received after the due date, you may be subject to a late fee. (Fee amount may vary based on state law.)
PAYMENT TERMS
Do not deduct from the amount due for policy changes that are pending. Premium adjustments for the current term will be
spread evenly over the remaining billing periods left in the policy. Prior term endorsement and/or adjustments will be
billed/credited in full.
Your account balance is the total amount owed as of the invoice issue date shown. Any changes to your account that are not
on this invoice will be reflected on future statements.
By payment of the premium due, the Named Insured accepts these billing provisions:
Your payment will be applied to the premium due for the entire account. Alternate payment instructions will not be
honored.
Return premium for a policy change or cancellation of one or more policies in the account will be applied to the
unpaid balance of the account. If there is no balance due on your account, a check will be issued for the amount of
the credit balance.
If the minimum due is not paid by the due date, all policies in the account will be subject to cancellation or expiration.
Payment processing is an administrative function; therefore, if your payment is received after the date of cancellation,
we reserve the right to process your check and return any unearned premium without obligation to reinstate your
policies.
When you provide a check as payment, you authorize us either to use information from your check to make a one-
time electronic funds transfer from your account or to process the payment as a check transaction.
CHANGE OF ADDRESS
Please complete this form and mark the Change of Address box on the front.
Name:
Address:
City:
State: Zip Code:
Phone:
YOUR COMPANY NAME COMMERCIAL ACCOUNT
1234 ELM STREET
YOUR CITY IA 55555-5555
Account: 0X00000
Invoice: A-56240052
Date: 05/04/15
Account Summary
Starting Account Payments New Activity Fees and Current Balance Minimum Due
Balance Received Adjustments 05/24/15
$28,866.00 $2,410.09 $0.00 $5.00 $26,460.91 $2,410.09
Activity Summary
Policy Transaction Transaction New Current Minimum
Date Type Activity Balance Due
Property
0A00000 - 16 $2,985.58 $271.42
Inland Marine
0C00000 - 16 $456.50 $41.50
General Liability (Occurrence)
0D00000 - 16 $5,143.42 $467.58
Business Auto
0E00000 - 16 $5,258.00 $478.00
Workers Compensation
0H00000 - 16 $12,464.83 $1,133.17
Data Compromise
0Q00000 - 16 $147.58 $13.42
Subtotal $0.00 <sBal> <sMin>
Account
05/04/15 Installment Fee $5.00 $5.00 $5.00
Pay in Full/Minimum Due $26,460.91 $2,410.09
Any change made to your account after the issue date of this invoice will be reflected on the next invoice.
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