AUTOMATIC PAYMENT TERMS AND CONDITIONS

AUTOMATIC PAYMENT TERMS AND CONDITIONS

Automatic Payments (EFT) Authorization Agreement

I authorize the Plymouth Rock Assurance Corporation and its affiliates and Plymouth Rock Management Company of New Jersey and the companies it manages (the “Companies”) to make periodic electronic fund withdrawals from the bank account provided in order to pay my insurance premiums as they come due. I authorize my financial institution to accept electronic fund withdrawals, which may include an installment fee*, initiated by the Companies. If any withdrawal is returned due to insufficient funds, I authorize the Companies to withdraw a non-sufficient funds fee** from my account as a reasonable processing fee. I understand that I can withdraw my consent to use electronic fund withdrawals for the payment of my policy premium at any time by providing the Companies in writing my request to withdraw such consent. I understand that I have the right to make a stop payment of a preauthorized electronic funds transfer by notifying my financial institution orally or in writing at any time up to three (3) business days preceding the scheduled date of the transfer. I authorize the Companies to reduce the amount of any prescheduled withdrawal if the actual amount due is less than the prescheduled withdrawal for any reason. Any notice hereunder will not be deemed effective until the Companies has had a reasonable time to act.

*The following companies charge a $2 installment fee: High Point Property and Casualty Insurance Company, Palisades Insurance Company, Rider Insurance Company and Teachers Auto Insurance Company of New Jersey.

**The non-sufficient funds fee is $25 with the exception of:

Connecticut customers with policies effective prior to 11/16/2015 $20
New Jersey customers, including Teachers’ Insurance customers $15
New York customers $20

Automatic Payment (Recurring Credit Card) Authorization Agreement – Connecticut, Massachusetts, New Hampshire, New York, New Jersey and Pennsylvania

I authorize the Plymouth Rock Assurance Corporation and its affiliates and Plymouth Rock Management Company of New Jersey and the companies it manages (the “Companies”) to make periodic charges to the credit card account provided in order to pay my insurance premiums and associated charges* as they come due. I certify that I am an authorized user of this credit card account and will not dispute these periodic payments with my bank or credit card company so long as the payment amounts are correct in accordance with the payment plan I selected. If I am an agent or someone acting on behalf of the insured, I represent that the insured has authorized me to act on their behalf and has been advised of the terms contained in this authorization. I understand that this authorization will remain in effect for the current policy term(s) and any renewals until I cancel it in writing. I agree to notify the Companies in writing of any changes in my account information or termination of this authorization at least 7 days prior to the next scheduled payment date. I further agree that if my credit card becomes invalid, I will provide new valid credit card account information upon request, or will make timely premium payments by another method offered by the Companies. Any notice hereunder will not be deemed effective until the Companies have had a reasonable time to act.

*I understand that the following installment fees may be applied to each periodic payment:

Connecticut, Massachusetts and New Hampshire

Auto $6
Home $9

New York

Auto $6
Home $6

New Jersey and Pennsylvania

Auto** $9
Home $9

**The installment fee for policies underwritten by Plymouth Rock Assurance Preferred Corporation in Pennsylvania is $6.