Agent Submits Customer Check

Agent Submits A Customer Check

NO FEE Charged to Customer
Payment requests received by 1:00PM Arizona time on business days, will be processed that business day.
Payment requests received after 1:00PM Arizona time, will be processed the next business day.
Agent - if it is close to the Cancellation Date, call our office to advise us you have uploaded the payment, to prevent the Cancellation Notice from being mailed.

Customer Information

First Name or Business Name		No ' in name
Last Name
APFC Account Number		Customer's 8 digit account number
Best Customer Telephone		212-555-6666

Customer's Check Information - refer to picture of check above for help
Bank Name
Bank Routing Number		9 Digits
Checking Account #
Amount of Check		Enter only numbers and decimal point
Verify the information entered is correct before submitting. We do not verify your entries.

	ARIZONA PREMIUM FINANCE CO.
	....The Driving Force in Premium Finance 800-873-2732