Avoid late fees and save money in reduced billing fees by using our Electronic Fund Transfer (EFT) payment method.
To sign up for this easy-to-use method of paying your bill, please complete the following information.
Electronic Funds Withdrawal Authorization
Example of location of ABA Routing Code (Bank Identification number) and customer Bank Account Number
Please debit my checking or savings payment to (The Company) for insurance premiums, including fees and subsequent renewals.
I Agree that:
1. The Company does not need to notify me that premiums are due as long as this automatic payment plan is in effect. In addition, no premium or any portion of a premium will be considered paid unless The Company receives payment at its Home Office. If my account has insufficient funds on the date of automatic payment deduction, The Company will attempt a second deduction within a few days. I will pay any charges for the initial non-payment or second payment. If funds are not available at the second attempt, my account will be removed from this payment option and direct billed.
2. If the authorization is for a policy with a payment arrangement that is for any payment plan we offer for EFT, this authorization constitutes approval to change the payment arrangement.
3. It is not necessary for any officer or employee of The Company to sign a debit to my account.
4. The Company will incur no liability if my account has insufficient funds for a payment because of an automatic deduction.
5. The Electronic Fund Plan will continue unless terminated by The Company or me with thirty (30) days written notice to either party. In addition, The Company may terminate the plan immediately if any debit is not paid upon request.
I understand that by typing my name in the box labeled "Name" at the bottom of the authorization screen and clicking the button marked "Submit", I have created a legally binding signature on this authorization form. This electronic signature is the equivalent of my handwritten signature. This signature shall be valid evidence of my intent and agreement to be bound to the Terms and Conditions
of this website. I further acknowledge that I am the owner or I am authorized to use the above account.
Please enter your signature exactly as you have entered it on the Electronic Funds Authorization Form <Account Holder Name>
Dairyland Cycle® and Dairyland Auto® property and casualty coverages are underwritten by a member of the Sentry Insurance Group, Stevens Point, WI. For a complete listing of companies, visit sentry.com. In Texas, coverages are underwritten by Dairyland County Mutual Insurance Company of Texas, Austin, TX. In California, coverages are underwritten by Viking Insurance Company of Wisconsin, Stevens Point, WI. Policies, coverages, benefits and discounts are not available in all states. Savings based upon all available discounts. See your policy for complete coverage details. Dairyland Cycle® is neither endorsed by nor affiliated with Harley-Davidson, Inc. or the Harley Owners Group. EFT options vary by state and federal regulations.