THA INC PERSONAL PAYMENTS PAGE(HOME, AUTO, HEALTH)
To:
Toby Hansen Agency Inc.
THA INC PERSONAL INSURANCE PAYMENTS (HOME, AUTO, TOYS, HEALTH)
Client Name (if different)
Business Payment
[Required]
First Name
[Required]
Last Name
[Required]
Email Address
@
Payment Amount
Select payment method
e-Check
Fee:
$1.00
Amount:
Processing time:
up to 5 business days
Bank account type
Business - Checking
Personal - Checking
Business - Savings
Personal - Savings
Address
City
State
~Please select~
~Please select~
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
#
Check Date
Check Number
#
Payment for
~Please select~
PLEASE CALL ME ON THIS
MY HOME OR RENTERS POLICY
MY PERSONAL AUTO POLICY
MY PERSONAL BOAT,RV, MOTORCYCLE, OR OTHER TOY
MY PERSONAL UMBRELLA POLICY
Policy/Account
Company
Memo
Edit Memo
Bank Routing Number
#
Bank Name
Bank Account Number
#
Confirm Account Number
#
Pay
×
Close
Please Confirm
Are you sure you want to initiate a payment for:
Customer's Email:
Client Name (if different):
Business Name:
First Name:
Last Name:
Payment for:
Policy/Account:
×
Close
Add new Payment/Receipt Item
Payment for
~Please select~
PLEASE CALL ME ON THIS
MY HOME OR RENTERS POLICY
MY PERSONAL AUTO POLICY
MY PERSONAL BOAT,RV, MOTORCYCLE, OR OTHER TOY
MY PERSONAL UMBRELLA POLICY
Policy/Account
Company
Amount
Transaction Type
~please select~
Agency Retained Funds (ARF)
Electronic Funds Transfer (EFT)
×
Close
Please Read Carefully...
I authorize
to
debit/process
check for
to my bank account based on all as agreed upon and in compliance with the
terms and conditions.
PROCEED