Payments Due
		Policy	Due Date	Min. Amount Due	Bill
		A2052160	08/01/2013	$111.33	View
		HA190000	07/15/2013	$143.33	View
		U1000001	07/11/2013	$251.00	View
Payment

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Posting Date:

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Terms:

I authorize Ebix, its affiliates and the financial institution designated to deduct payments from my account through electronic funds transfer. I have sufficient funds in the account provided for all electronic debit entries. Electronic debit entries shall be initiated by Ebix to pay premiums and other charges and fees, including, if applicable, any fee charged after the policy's termination effective date, for or associated with the above listed policies or other policies as authorized and the entries shall constitute my receipt for the transaction(s).

  Yes, I agree to the terms and Conditions

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Bank Routing Number:

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Confrim Bank Account Number:

Posting Date:

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Payment Frequency:

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Bank Account Type:

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Terms:

I authorize Ebix, its affiliates and the financial institution designated to deduct payments from my account through electronic funds transfer. I have sufficient funds in the account provided for all electronic debit entries. Electronic debit entries shall be initiated by Ebix to pay premiums and other charges and fees, including, if applicable, any fee charged after the policy's termination effective date, for or associated with the above listed policies or other policies as authorized and the entries shall constitute my receipt for the transaction(s).

  Yes, I agree to the terms and Conditions

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