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All form fields
must be completed except where noted. Incomplete
form fields will not allow the form to be
submitted to Great Lakes Mutual Insurance.
Recurring Payment Authorization
Here's How Recurring Payments Work:
You authorize
regularly scheduled charges to your
checking/savings account or credit card
according to the payment plan you have selected.
A $5.00 installment fee will be applied to
semi-annual or quarterly payments. A receipt for
each payment will be emailed to you. You agree
that no prior-notification will be provided
unless the date or amount changes, in which case
you will receive notice from us at least 10 days
prior to the payment being collected.
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