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Mark Thompson

Mark Thompson Insurance Agency, LLC

370 Neff Ave g, Harrisonburg, VA 22801, USA
(540) 434-1144
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Dan Harris

Daniel Harris Insurance Agency, Inc.

111 Oakwood Dr, Bridgewater, VA 22812, USA
(540) 828-2577
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Sign Up for Automatic Bill Pay

Enroll by providing the authorization form to your local agent, who will finalize set-up.

  • No installment fees. Save on postage.
  • The monthly premium is deducted from your checking or savings account.
  • Select your monthly electronic payment date (dates available between 1st – 28th).
  • If the policy is updated, you’ll receive notification of deduction changes.
  • You may return to quarterly, semi-annual, or annual billing at any time.
  • To enroll:
    • Complete the form
    • Make a down payment equal to 10% of your annual premium (see the back of form for payment methods)
    • Mail, fax, or deliver this completed form to your local agent’s office

Download this form

Provide completed automatic bill pay form to your local agent.

Download VA Form
Download PA Form