Request EFT Form - Sellers Insurance

Now Available: Automatic Payment Withdrawal!

At Sellers & Company, we value your feedback. Many of you asked to set up automatic payments for your policies administered by our Agency, and we heard you! EFT service is now available at NO COST to you!

To enroll, please complete this form, and we will email you a link to complete your personalized enrollment form via DocuSign within 1-2 business days:

Insured's Name *

First Name

Last Name

Email Address *

Phone Number *

How would you like to receive your enrollment form?

Fax Number (Not required unless you would like us to fax your form.)

Address (Not required unless you would like us to mail your form)

Address

City

State

Postal Code

Country

Call Us: 716.627.5400 or 800.333.5440

Now Available: Automatic Payment Withdrawal!

To enroll, please complete this form, and we will email you a link to complete your personalized enrollment form via DocuSign within 1-2 business days:

Quick Links

Contact Us

716-627-5400 / 800-333-5440

Our Office