Vertafore FSC, Inc. Payment Enrollment Form 2026

1. Click ‘Get Form’ to open the Vertafore FSC, Inc. Payment Enrollment Form in the editor.
2. Begin by entering your Agency/Company Name and FSC Account Number(s) in the designated fields.
3. Provide your Billing Email Address to ensure you receive important notifications regarding your payments.
4. Select one of the two payment options: either Automatic Debit/eCheck or Credit Card. Make sure to check only one box.
5. If you choose Automatic Debit/eCheck, fill in the Depository Name, Branch, City, State, and Zip Code. Then select whether it’s a Checking or Savings Account and provide your Account Number and Routing Number.
6. For Credit Card option, enter your card details including Account Number, Expiration Date, and CSC number. Also provide the Cardholder Name and Billing Address.
7. Sign and date the form where indicated. If using eCheck, remember to attach a voided check.
8. Once completed, save your changes and follow any additional instructions for submission.

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