I hereby authorize MWG Administrators to withdraw payments from the information I have provided above and by signing below I agree to the following terms for all relevant plans. I agree each payment shall be the same as if it were an instrument personally signed by me. This authorization will remain in effect until revoked by me in writing. In addition, I have the right to stop payment of a charge by timely notification to my Financial Institution prior to charging my account. I understand, however, both the Financial Institution and MWG Administrators reserve the right to terminate this payment plan (or my participation therein). If the premium amount changes, I will be notified in writing prior to any changes in the amount deducted from my account. Payments will be charged to this account on the 1st day of the month unless otherwise agreed upon by MWG Administrators.
MWG Administrators will send a notice of payment not honored. Payments not honored will not be submitted a second time. If a payment is not honored, my insurance terminates 10 days after notice has been sent. If I wish to continue my insurance after a payment is not honored, MWG Administrators must receive full payment prior to the end of that month. Reinstatement is only possible within 60 days of the not honored payment after which no reinstatement is possible. After two payments are not honored, reinstatement is not possible.
I also understand I have the right to terminate this reoccurring draft by contacting Morgan White Administrators, Inc. via mail or fax at the following address:
Morgan White Administrators, Inc.
P.O. Box 14067
Jackson, MS 39236
Phone: 800-800-1397
Fax: 601-956-3795
