Common Contracts
2 similar Authorization Agreement contracts
AGREEMENTAuthorization Agreement • October 25th, 2023
Deduct ongoing monthly premium payments from my designated checking or savings account. If the withdrawal date falls on a non-business day or a holiday, the premium payment will be deducted from my account on the next business day. (Please note that coverage cannot be issued until the first month of premium has been received in our office, unless you have authorized BCBSMT to deduct the initial payment upon receipt of your application).
AGREEMENTAuthorization Agreement • June 21st, 2013
Deduct ongoing monthly premium payments from my designated checking or savings account. If the withdrawal date falls on a non-business day or a holiday, the premium payment will be deducted from my account on the next business day. (Please note that coverage cannot be issued until the first month of premium has been received in our office, unless you have authorized BCBSMT to deduct the initial payment upon receipt of your application).
