Update Payment Details

This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Business Name (if applicable)

Phone(Required)

Email(Required)

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

What do you need to do?(Required)

Start a New Policy

Update Billing on an Existing Policy

Effective Date(Required)

As Quoted

Specific Date

Policy Start Date(Required)

Policy Number

Found on your policy documents or billing statement. Leave blank if you don’t have it handy.

Payment Type(Required)

ACH / EFT (Bank Account)

Credit Card

Card Type(Required)

Visa

Mastercard

Discover

AMEX

Card Number(Required)

Expiration (MM/YY)(Required)

CVV(Required)

Confirm Billing ZIP Code(Required)

Re-enter the ZIP code on your card’s billing address.

Routing Number(Required)

Account Number(Required)

Account Type(Required)

Payment Option(Required)

Pay in Full

Monthly Installments

Monthly payment plans may include a monthly service fee charged by the carrier — see your quote for fees.

Authorization(Required)

I authorize Vantage Point Risk to securely share my payment information with the insurance carrier for the purpose of initiating or updating my insurance policy billing. I understand that this form does not process any payment and is solely for secure data collection.

Signed By (type your full legal name)(Required)

Date(Required)

CAPTCHA

Please note: many carriers charge a 2.5%–3% credit card processing fee if it isn’t already included in the service or premium fees shown on your quote. If you’d like to confirm the exact fee first, contact us before we process your payment — we’re happy to verify it with the carrier.

Update Your Payment Details