Make a Payment - Bank Account Deduction

Complete and submit the form below to have a premium payment deducted from a bank account. Questions? Please call 1-800-523-9100. NY Residents call 1-800-323-4542.

Your transaction will be processed in one to three business days.

(*) Means required field


Please complete the following information about the person we insure:

Example: Jr, Sr, III.


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If you are not the insured, please complete the following:


Please provide the following:

Example: jdoe@domainname.com (no spaces)
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* What Do You Wish to Pay:

Enter Company Name, Policy Number(s) and Amounts

To pay for more than one policy click the Add link.

Company Name: Please select the company name shown at the top of your premium notice. If you have policies with both companies you will need to submit two separate payment requests.

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Banking Information

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I certify that I am the account holder for the bank account named above. By clicking on 'I Agree', I authorize Colonial Penn Life Insurance Company to debit the bank account shown above for the amount of the insurance premium payment shown above. I authorize the bank named above to deduct the insurance premium from this account. First drafts returned for insufficient funds will be resubmitted a second time.