As a convenience to me, I hereby request and authorize the Farmers Insurance Exchange to initiate electronic funds transfer withdrawals, by debiting my bank or credit union account or charging my debit \ credit card, either electronically or by any other method, and I hereby request and authorize my bank or credit union to pay and charge such amounts to my account. Any credits that are applied to my account may result in a revised minimum due amount for the current statement. I understand that if, at any time, I change financial institutions and/or accounts, this authorization still applies. This authorization is to remain in effect until the Company has received notification of its termination, in such time and manner as to afford the Company a reasonable opportunity to act upon it. I understand and agree that in the event that any withdrawal, charge or debit, or electronic funds transfer is dishonored or refused by my financial institution, electronic funds transfer withdrawals and charges will be discontinued. I also agree and understand that I will then be responsible for remitting all premium payments on or before the premium billing due date.

Mailing Address:
Farmers Insurance Exchange
6301 Owensmouth Avenue Woodland Hills, CA 91367
ATTENTION: Online Billing Manager