Online Checkpay

Make your insurance payment online with a check. Simply complete the form below, and yourchecking account will be drafted for the amount authorized.

All orders will be processed by:

 

RPS Continental
PO Box 1820
Roswell, GA 30077

Telephone: + 1 770-442-8727 x 105
FAX: + 1 770-751-0871
E-mail:roswell.rps.Agency_Accounting@rpsins.com

Name:
Email Address:
Company:
Mailing Address: 
City, State, Zip:  , 
Phone: 
Account Number:

Comments:

 

Online CHECK Info
(USA only) 
Please use the check
at the right to complete
the information below.
check 
*The sets of  numbers are not always in this order
Name On Check ("A" from above)
Address on Check: ("A" from  above)
City / St / Zip on Check: ("A" from  above)
Bank Name: ("B" from above)
Bank City & State: ("C" from above)
Check Number: ("D" from above)
A.B.A. Fraction: ("E" from above)
Routing Number (9 Digits): ("F" from above)
Account Number: ("G" from above)
Amount of Check:

By submitting this form, you are giving RPS Continental  permission to draft a check on your checking  account in the amount listed directly above this box.