For Customer Support, Call 1-800-523-9100

To add coverage, call 1-877-877-8052

New York Residents call 1-800-323-4542
Call Center Hours

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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:

Title: MrMrsMsMiss

First Name of Insured: *

Middle Initial:

Last Name of Insured: *

Suffix:

Example: Jr, Sr, III.

Street address: *

City: *

State: *

Zip/Postal Code: *

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

First Name:

Middle Initial:

Last Name:

Relationship to the Insured:

Please provide the following:

Your E-mail: *

Example: jdoe@domainname.com (no spaces)

Your Daytime Telephone: *

( ) - -

* 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.

Policy Number: Payment Amount:

$ Remove

Add

Banking Information

Bank Name: *

Bank Telephone No:

( ) - -

Bank Account Number: *

Verify Bank Account Number: *

Type of Account: * Checking
Savings
Money Market

Bank Routing Number
(9 digits): *

check

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.

Your name, as it appears on your bank account: *

I Agree

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Colonial Penn Life Insurance Company
Bankers Conseco Life Insurance Company

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Home of the Colonial Penn® Program

The Colonial Penn® Program is underwritten in most states by and is a registered trademark licensed by Colonial Penn Life Insurance Co, Philadelphia, PA. For policies issued in NY, the Colonial Penn® Program is underwritten by and is a registered trademark licensed by Bankers Conseco Life Insurance Co, Jericho, NY. Colonial Penn Life Insurance Co is not licensed in and does not solicit business in the state of New York. Policies underwritten by Intramerica Life Insurance Co are administered by Bankers Conseco Life Insurance Co.