TERMS & CONDITIONS:

Automatic payments will be withdrawn on the due date, and you will be supplied a 'Pre-Authorized Payment Schedule' for your records. The schedule will show the dates the withdrawal will be made and the amount to be withdrawn. The direct payment withdrawal will remain in effect unless terminated by you or by company request.

ACH is defined as: electronic funds transferred from a checking or savings account thru an automated clearing house. Account is defined to include the checking account, savings account or credit card account stated in this authorization.

Return Premiums: In the event of policy cancellation, any return premiums will be sent in a reasonable time to the named insured on the policy.

I/we understand that it takes several days to set up the first automatic withdrawal and that initial or down-payments may need to be made by another method until the automatic withdrawal is set up. I/we agree that Inland Mutual may debit my/our account or credit card for all charges due for the Policy(s) and I/we understand and agree that if a payment is missed, Inland Mutual may debit the account or credit card on the scheduled debit date as well as all overdue payments. I/we also authorize debits of premium payments and other charges due on subsequent renewals of the policy.

Inland Mutual Insurance Company is transitioning to a new electronic payment processor effective February 2, 2026. Please be advised that if you choose to pay your premium by Credit/Debit Card, a 3.5% service fee will be added to any payment made on or after that date. The service fee is being collected by the Credit/Debit card payment processor, not by Inland Mutual Insurance Company. Note that payment service fees are fully earned at time of payment. You may continue to pay your premium by regular check, money order, electronic funds transfer (ACH) or cash at no additional cost to you. Do not send cash through the mail.

A billing statement or pre-authorized payment schedule showing exact scheduled dates and amounts will be provided at least 10 days prior to the first withdrawal or charge. I/we agree that if the amount of a scheduled debit varies by more than $7.00 from the previous debit or if the timing or frequency of one or more of the withdrawals or charges changes, Inland Mutual will send written notice of the amount and/or date of the scheduled debit at least 10 days before the scheduled debit.

Inland Mutual will incur no liability as a result of a debit or charge being dishonored by your financial institution. If a debit or charge is not honored by the financial institution, Inland Mutual will not consider the payment to have been made.

I/we understand that if premiums are not paid within the applicable grace period the policy(s) will terminate. I/we acknowledge that the debit appearing on your bank statement will constitute your receipt for payment, but no payment is deemed made until Inland Mutual actually receives payment. Signing and submitting this authorization does not mean that insurance coverage is effective. Coverage is effective only as stated in the declarations page(s) provided by Inland Mutual and is effective when all applicable terms and conditions stated therein have been met. This authorization does not modify the terms of any insurance policy, nor does it constitute acceptance of any offer that may be made by Inland Mutual to renew an insurance policy.

This authorization must be signed and dated by the Account owner as his/her name appears on the bank records for the account. By signing this authorization, you represent and warrant to Inland Mutual that you are the owner of the account and that you have the legal authority to authorize debits against the account. If the account is owned by a legal entity (such as a corporation or LLC), you represent and warrant that you have legal authority to act on behalf of that entity with this authorization.