Insurer Worksheet and Payment

Notice to Customers Using a Business DDA Bank Account
NCR utilizes Fifth Third Bank to originate ACH transactions to the Federal Reserve Bank. Under the contractual agreement, items originated by NCR through Fifth Third Bank will have an origination ID of 1810599849 or 9810599849 and the ACH routing number for Fifth Third Bank is 063103915. If a business bank account is being used to submit an e-Check payment, please instruct your bank to accept an ACH debit from the origination IDs and ACH Routing number above. In the event that your payment is returned for any reason, this payment and the associated transaction will be invalid.

X $1.00
$ .00

"Total Earned Car Years" is defined as the total number of private passenger motor vehicle insurance policies, providing physical damage insurance coverage, written in the State of Illinois during the preceding calendar year.

"Private Passenger Motor Vehicle" is defined as any private passenger car, station wagon, jeep, or pickup truck with a load capacity of 1,500 pounds or less, not used principally for business purposes, and small farm trucks. This term includes, but is not limited to, jeeps, pick-up trucks, mini-vans, vans and conversion vans. This term excludes uninsured motor vehicles, motorcycles, motor homes, motor scooters, golf carts, off-road recreational vehicles, all terrain vehicles, off highway motorcycles, and special motor equipment as defined under Chapter 1 of the Illinois Vehicle Code [625 ILCS 5/Ch. 1].