Billing Info Provide your preferred billing info below for your insurance recommendation. RiskWell adheres to industry best practices for the handling and safeguarding of all sensitive data entrusted to us. Is this billing setup for a new program or a renewal of an existing program?(Required)New programRenewal programType of account for transaction?(Required)This will allow us to direct your billing information to the correct agent. Personal LinesCommercialREIHow do you want to pay the balance due for your insurance program?(Required)If you have more than one policy to pay for, please select the option(s) you prefer. Bank ACH / EFT Credit / Debit Card Escrow Account / Title Company Preferred Billing Installment MethodThe only options are Pay In Full, Monthly ACH/EFT or Pay Via Third Party (Escrow Account or Title Co)Pay In FullAutomatic Monthly Payment (ACH/EFT or CC)All fees charged by card issuers are the responsibility of the policyholder. Typical card processing fees range from 2.75%-3.25% of the total amount due. To avoid these fees, please select Bank ACH/EFT from the dropdown.Is this the same Lienholder/Mortgagee we already have on file?Yes, the sameNo, it's differentName and contact info for Escrow / TitleWe will collect the necessary info from your loan or escrow officerPhone NumberEmail(Required) Bank Account Holder Name(Required) Bank Routing Number(Required) Bank Account Number(Required) Credit/Debit Cardholder Name(Required) Card Type(Required)American ExpressMastercardVisaCredit/Debit Card Number(Required) Card Expiration Month(Required) Card Expiration Year(Required) Credit/Debit Card Security Code(Required) Credit/Debit Card Zip Code(Required) CAPTCHAPayment Authorization(Required)NOTE: THESE TERMS AND CONDITIONS HAVE BEEN MODIFIED AS OF MAY 2022 Your use of the RISKWELL Online Payment Service (hereinafter referred to as “Online Payment” or the “Online Payment Service”) is subject to all terms and conditions contained in this Online Payment Service Agreement (this "Agreement"). Please read the Agreement carefully before proceeding, as your use of the Online Payment Service constitutes your acknowledgment of its terms and conditions and your agreement to be bound thereby. I. Your Role. Your role is extremely important in the prevention of any wrongful use of your bank account information. You must promptly examine your bank statements upon receipt. If you believe your bank statement is wrong or if you need more information about a transaction, please contact RISKWELL. The Online Payment Service does not validate its users’ account information. Incorrectly entering your bank account number or your bank's 9-digit ABA routing number can result in the rejection of your Online Payment request. Users of the Online Payment Service are solely responsible for ensuring, before submitting an Online Payment request, that their account is ACH debit-eligible and that they have entered the correct bank account and ABA routing numbers. If you provide an incorrect bank account number or 9-digit ABA bank routing number or your electronic transfer is dishonored by your bank for any reason, you will be notified electronically via email that your Online Payment request was rejected. The notice will be sent to the email address as entered on the payment site. Non-delivery or non-receipt of such electronic notice does not under any circumstances entitle the user to any waiver of fees assessed because of any rejected Online Payment request. II. SECURITY PROCEDURES 1. Encryption. Data transferred via the Online Payment Service is encrypted to provide transmission security. Notwithstanding the efforts of the RISKWELL to ensure that information transmitted to and from the Online Payment Service is secure, you acknowledge that the Internet is inherently insecure and that all data transfers, including email, occur openly on the Internet and can potentially be monitored and read by unauthorized parties. The RISKWELL cannot and does not guarantee the security of data transfers using the Online Payment Service or email transmittals to or from the RISKWELL. You agree that all security procedures used by the RISKWELL are commercially reasonable security procedures and you assume all risk of loss from unauthorized transactions involving your account. You further acknowledge that the RISKWELL reserves the right to change the security procedures at any time upon notice to you (if such notice is required by law), and you agree that your continued use of the Online Payment Service shall evidence your acceptance of any such changed procedures and your acknowledgment as to the commercial reasonableness thereof. 2. Exercise Reasonable Care. RISKWELL will exercise good faith and reasonable care in processing your transactions. You will similarly exercise good faith and reasonable care in observing and maintaining security procedures, in communicating with the RISKWELL, and in reviewing account statements for any errors or discrepancies. III. GENERAL TERMS AND CONDITIONS 1. Terms of Agreement. You understand and agree to the terms and conditions set forth in this Agreement. In the event of any conflict between one or more provisions of this Agreement and the provisions of any other applicable agreement, the provisions of this Agreement will control. Your use of the Online Payment Service is subject to all applicable laws and regulations, all of which, when taken together with this Agreement, shall constitute the complete agreement between you and the RISKWELL regarding the subject matter hereof. 2. Electronic Funds Transfer Act. This Agreement applies to personal accounts and business accounts, except as otherwise noted. As personal accounts, may be subject to the Electronic Funds Transfer Act ("EFTA"), some personal accounts will be governed both by the rules of the EFTA and this Agreement. If the EFTA applies to an account and there is a conflict between the rules of the EFTA and this Agreement, the EFTA's provisions will control. 3. Limits on Transfers. Your ability to transfer funds between certain accounts is limited by federal law. For example, you can make no more than six (6) transfers from a Statement Savings, Passbook Savings, Ultimate Savings, or Money Market account during each statement period, and in the case of a Money Market account, no more than three (3) of such transfers may be made by check, draft, or similar order made by you and payable to a third party. Payments made using the Online Payment Service may be counted against the permissible number of transfers. Your bank may reserve the right to limit the frequency and dollar amount of transactions from your accounts for security reasons. 4. Changes in Terms of Agreement and Availability of Online Payment Service. RISKWELL reserves the right to modify the terms of this Agreement at any time. RISKWELL further reserves the right to terminate the Online Payment Service, to make access thereto unavailable, or to modify the online content thereof, with or without notice at any time. 5. Information Accuracy. RISKWELL strives to provide complete, accurate, and timely account information. All information provided to you by RISKWELL is either generated by RISKWELL or obtained from sources believed by RISKWELL to be accurate and reliable. However, because of the possibility of human, electronic, and mechanical errors; delayed updates; and other factors, such as the difficulty of securing a website from unauthorized alterations or the occurrence of a system breakdown or other unavailability, RISKWELL does not provide any representations or warranties regarding the Online Payment Service, RISKWELL website, or any information contained therein, and RISKWELL will not be liable to you if any such information is unavailable, delayed, or inaccurate. THE ONLINE PAYMENT SERVICE, RISKWELL WEBSITE, AND ALL INFORMATION CONTAINED THEREIN IS PROVIDED "AS IS" AND WITH ALL FAULTS, AND RISKWELL MAKES NO REPRESENTATIONS AND DISCLAIMS ALL WARRANTIES (EXPRESS OR IMPLIED) OF EVERY KIND, INCLUDING WARRANTIES OR DUTIES (IF ANY) AS TO ACCURACY, TIMELINESS, COMPLETENESS, SUITABILITY, AVAILABILITY, MERCHANTABILITY, FITNESS FOR ANY PARTICULAR PURPOSE, OR LACK OF NEGLIGENCE OR VIRUSES. RISKWELL makes no warranties against infringement or of quiet enjoyment, nor any other express or implied warranties of any kind whatsoever. 6. Computer Virus Information. It is possible to contract a computer virus by using the Internet or materials downloaded from it. RISKWELL attempts to keep its website virus-free, but RISKWELL cannot guarantee that the website or any software or other information downloaded from it will be free of viruses. RISKWELL is not responsible for any electronic viruses or other detrimental computer hardware or software infections that you may encounter, including, without limitation, any computer virus-related problems that may be associated your use of the Online Payment Service. 7. Your Computer and Software. You are responsible for the installation, maintenance, and operation of your computer and your browser software. You assume all risk of error, failure, or non-performance, including the risk that you do not operate your computer or your software properly. RISKWELL is not responsible for any errors or failures resulting from any malfunction of your computer or your software. RISKWELL shall have no liability to you for any damage or other loss, whether actual, special, direct, indirect, consequential, punitive, or otherwise, which you may suffer or incur by reason of your use of the Online Payment Service or RISKWELL website. RISKWELL MAKES NO WARRANTIES TO YOU REGARDING YOUR COMPUTER OR YOUR SOFTWARE, INCLUDING WITHOUT LIMITATION ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. IV. LIMITATION OF LIABILITY 1. Limitation of Liability for Loss. To the fullest extent allowed by law, you agree that RISKWELL will be liable to you or any third party for any loss, property damage, bodily injury; any indirect, consequential, or incidental damages (including, but not limited to, lost profits or lost opportunity); or any other actual, special, or punitive damages whatsoever, which (i) arise out of or are directly or indirectly related to the Online Payment Service or any use of RISKWELL website or the information contained therein, or (ii) result from any failure to complete any transaction, even if RISKWELL has been advised of the possibility of such damages. This exclusion of damages includes damages claimed in any cause of action whatsoever, including, but not limited to, legal or equitable proceedings and claims relating to contract, tort, or products liability. 2. Specific Situations. Notwithstanding anything to the contrary set forth herein or elsewhere, RISKWELL will have no liability whatsoever if, without limitation: • Through no fault of RISKWELL, you do not have enough money in your account to make a transfer; • A transfer would cause your balance to go over the credit limit on your personal reserve account or any other line of credit product; • Circumstances beyond RISKWELL’s control (such as fire, flood, or improper transmission or handling of payments by a third party, including the post office) prevent a transfer of funds; • The funds in your account are subject to legal process or other encumbrance restricting transfer; • Your account is closed or frozen to transactions; • RISKWELL has completed any transaction requested by your authorized agent; • You or anyone else acting on your behalf (whether or not authorized) commits any fraud, misrepresentation, or deceit, or violates any applicable law or regulation; • Any electronic terminal, telecommunication device, or any part of the electronic fund transfer system is not working properly; • You have not properly followed RISKWELL’s instructions as to how to make a transaction, or you provide RISKWELL with incorrect, incomplete, or inaccurate information, whether electronically, orally or in writing; or 3. Time Limitation. During and following the term of this Agreement, in any event wherein you believe RISKWELL has breached the terms hereof or is liable hereunder for any reason, you agree to contact RISKWELL within five business days following the date on which the breach occurred or the liability arose 4. Your Liability. Except as otherwise provided by law, you will be liable for any loss or damage resulting from your breach of this Agreement or to which your negligence contributed, or which resulted from unauthorized, fraudulent, or dishonest acts by others (other than RISKWELL). Such liability includes instances wherein someone effects one or more transactions to your detriment. You are liable for all payments that you make or which are made or requested by your agent, even if such agent exceeds its authority in so doing, and even if such agent is not an authorized signer on your account. V. MISCELLANEOUS TERMS AND CONDITIONS 1. Waiver and Severability. RISKWELL may delay exercising its rights hereunder without thereby waiving them. A waiver or partial exercise of one right does not constitute a waiver of any other rights or of the same right at another time. If any provision of this Agreement, or its application to any person or set of circumstances, is held invalid or unenforceable to any extent, the remainder of this Agreement, and its application to any other persons or sets of circumstances, shall not be impaired or otherwise affected. 2. RISKWELL’s Right to Terminate this Agreement. RISKWELL reserves the right to unilaterally terminate this Agreement, the Online Payment Service and/or your access thereto, in whole or in part, at any time with or without notice. I agree to the above terms and conditions regarding the information provided on this form.Signature(Required)You may use your finger or mouse as needed to complete this signature confirmation.