COUNTRY MUTUAL INSURANCE COMPANY®
PAYMENT AUTHORIZATION (“Payment Authorization”)
Consent to Use of Electronic Signature and Record:
This Payment Authorization is an electronic record which will serve as the sole and authentic copy of the transaction. An electronic signature will also be used. By proceeding, you are consenting to do business with Company electronically in this manner. Clicking continue below will serve as your consent to the use of an electronic signature and an electronic record and also serves as your legally binding electronic signature on this Payment Authorization.
Payment Information
Payor (“I” or “me” or “you”) hereby authorizes COUNTRY Mutual Insurance Company® (“CMIC”) to charge my debit/credit card the appropriate dollar amount(s) on or around the date(s) indicated to pay the premium amount(s) associated with the policy(ies)/contract(s) purchased from CMIC, COUNTRY Preferred Insurance Company® (“CPIC”), and/or COUNTRY Casualty Insurance Company® (“CCIC”), and related fees. The above activity will hereinafter be referred to as a “transaction.”
I authorize CMIC to refund to me any payment in excess of the premium amount due, and, if necessary, apply the refund to the referenced debit/credit card and/or charge my debit/credit card to correct any transaction(s). To the extent that any funds are due to me, I authorize CMIC to electronically credit the referenced bank account.
I acknowledge that it is my responsibility to have sufficient funds available on this debit/credit card to cover this charge. In the event that a payment is returned for insufficient funds, I will be sent a separate correspondence from CMIC requesting a replacement payment covering the charge as well as any returned item fees. If payment is not received within the required timeframe, I understand my policy(ies)/contract(s) may lapse, and I may not have coverage.
I am authorized to initiate this debit/credit card transaction(s).
Combined Billing Information
I hereby authorize CMIC to combine on one billing account the property/casualty policy(ies)/contract(s) listed above, and any additional policy(ies)/contract(s) as necessary. I specifically agree that CMIC has the right to apply any sums received from me or on my behalf to any delinquencies applicable to this or any other billing account I have with CMIC regardless of my direction to the contrary. In consideration of CMIC agreeing to receive, transfer, or apply amounts received from me or on my behalf for the above policy(ies)/contract(s), I jointly and severally promise to pay CMIC the amount due by the respective due date(s). I further acknowledge that:
Terms and Conditions
Please confirm the details of this transaction(s). By electronically signing below (via signature pad, clicking a box, etc.), you accept this Payment Authorization and these Terms and Conditions, and your acceptance constitutes binding authorization to CMIC to initiate a one-time charge to your debit/credit card. A receipt of payment, including this Payment Authorization, will not be mailed and/or emailed to you. You have the option to print or download your receipt. If you do not wish to authorize this transaction(s), please exit the payment process.
This Payment Authorization is only valid for this transaction (one-time use). If this transaction is scheduled for a future date, this Payment Authorization will remain in full force and effect until it is either (1) terminated by you upon written notice; (2) terminated by CMIC upon written notice; or (3) the transaction has been processed. For any termination to be effective, the terminating party must provide three (3) business days’ prior notice. For any transaction scheduled for a future date, the termination of this Payment Authorization will result in the canceling this scheduled payment. You may terminate this Payment Authorization via your COUNTRY Financial online account (https://www.countryfinancial.com) or request CMIC terminate by (1) contacting your financial representative/specialist or insurance agent, or (2) calling the client service center at 1-866-COUNTRY (866-268-6879).
You understand the debit/credit card charge will be processed on the scheduled payment date(s) for the amount(s) due. You understand that a payment(s) with a scheduled date(s) on a Saturday, Sunday, or holiday may not be processed until the following business day.
If you have elected to receive information via email regarding payments, you agree to maintain a current/up-to-date email address with CMIC, and you will ensure that it is active and capable of receiving new emails. You will ensure that your email account has sufficient space for new emails and your email server and spam-blocking software do not block CMIC emails. You understand that CMIC is not responsible for problems arising from emails sent to an inactive/out-of-date email address, unless CMIC is solely negligent for using an incorrect address.
You authorize CMIC to use a third party to process the authorized payment(s) on its behalf.
It is recommended that this Payment Authorization be downloaded, saved, and/or printed and maintained for your records.
Privacy Policy: To view our privacy policy, go to https://www.countryfinancial.com/en/privacy-and-security/privacy-and-security-policy.html.
System Requirements/Equipment: CMIC uses encryption to make your information unreadable as it passes over the Internet. Therefore, CMIC strongly recommends that you use the latest version of your browser software for maximum security. Should CMIC make any changes to hardware or software requirements for electronic presentation such that you will no longer be capable of accessing or retaining your billing statements and notices electronically, CMIC will inform you of the revised hardware and software requirements.
CMIC reserves the right to change this Payment Authorization, which includes these Terms and Conditions, at any time, and, if changes are made, CMIC will inform you.