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Loudoun Mutual Insurance

Updated EFT/ACH Debit Authorization Form

Please note that our EFT/ACH Debit Authorization Form has been updated and that along with use of this updated form we no longer require the attachment of a voided check for the corresponding account.

If you keep electronic or paper copies of the previous form on hand to distribute to policyholders, please dispose of them and begin using this updated version effective immediately. This version will be part of invoice mailing in the coming days and is now available online in agent resources, the insured portal and on our website.

 A link to the updated form on our website is provided below and can be accessed routinely by navigating to the “Manuals & Forms” menu on the “For Our Agents” page at LoudounMutual.com. The form is the first item available under each line of business.

 Please be aware that this form contains personal identifying information (PII) and should be encrypted when being sent as an email attachment. If you do not have encryption software, please email billing@loudounmutual.com and a link will be provided to you.

 Thank you for your help in initiating use of this updated form. We hope it makes the automated payment process easier and more efficient for you and our policyholders. 

 Any questions about use of the updated form may be directed to billing@loudounmutual.com.

Thank you!  

Loudoun Mutual Inc.
15609 High St. Waterford
VA 20197

  

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