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PAYMENT CONFIRMATION

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RECURRING PAYMENTS OPTION

Your remaining payments will be processed automatically to your credit or debit card in accordance with your recurring payment authorization set forth below. Please print a copy of this page for your records.

I hereby authorize Direct General to submit a payment charge to my debit or credit card, in accordance with the dollar amount, frequency and other terms for the recurring payments displayed on this payment authorization page. The first payment will be processed by Direct today or the next business day. In the event I want to cease recurring billing for any reason, I will contact Direct General at the 877-463-4732 or at www.DirectGeneral.com. I acknowledge that if I cancel the Recurring Payment option, or Direct General is unable to obtain a scheduled payment for any reasons from my card issuer, Direct General may cancel my insurance policy(ies) in accordance with the terms of the policy and applicable law.

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If you need to make changes to your recurring payment selection, please contact our customer service department at 877-463-4732 from 6:30AM - 10:00PM CT Mon-Fri, 8:00AM - 5:00PM CT Sat or 10:00AM - 2:00PM CT Sun.