Down Payment - Stonemark

To process your down payment, complete the form below. Please allow up to 2 business days for processing your request.

I (we) hereby authorize IPFS Corporation, hereinafter called Lender, to initiate debit entries to the checking/savings account, depository name (hereinafter called DEPOSITORY) below and to debit the said account.

Form Completed By:
Agent / BrokerBorrower / Insured

Account Type
CheckingSavings

For Credit Card payments, please call 800.955.0083

Bank Name

Bank Routing Number
(Please double check your entry to avoid possible return fees. It MUST be 9 digits.)

Bank Account Number
(Please double check your entry to avoid possible return fees.)

Verify Bank Account Number

Name on Bank Account

I agree this authorization is to remain in full force and effect until Lender has received written notification from me of its termination in such time and in such manner as to afford Lender and DEPOSITORY a reasonable time to act on it. I understand that the amount being transferred from the account could vary based on changes made to the insurance coverage, and that I will be notified of the changes prior to the transfer effective date.

Borrower / Insured Name

Contact Phone #

Contact Email Address

Select one of the following:
Account # (begins with 1080)Quote Number

Account #

Quote Number

Payment Amount
$

I am an authorized signer or authorized representative for this account, and I have signed this sheet to certify this transaction.

Electronic signature of account holders or authorized signers

First

Last

By checking this box, you also agree to enroll in monthly ACH payments of your insurance policy. Past due payments will be debited immediately.

Financing is subject to agreement with all applicable terms and conditions, IPFS underwriting approval and final acceptance by IPFS. Coverage is not bound and not in-force upon payment submission.