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PACA363389101172011042225PMA - policy Esurance will notify...

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YIBIN LI 2855 Pinecreek Dr Apt F213 COSTA MESA, CA 92626 Policy Number PACA - 003633891 Effective Date 01/17/2011 Authorization of Electronic Fund Transfers As the accountholder, I authorize Esurance to charge my credit card identified below for remaining payments in this policy term in accordance with my payment schedule. 01/19/2011 $78.00 02/19/2011 $125.14 A $5.00 installment fee will be added to each payment. I also authorize Esurance to charge this card for all future payments upon renewal or a change to my
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Unformatted text preview: policy. Esurance will notify me via email of the schedule and amounts of any future and renewal payments, and send me an email reminder before each individual billing. I acknowledge my understanding of these terms and authorize these payments. Electronic Signature: YIBIN LI Date: 01/17/2011 Card Type: Credit Card Number: XXXX-XXXX-XXXX-8423 Cardholder Name: YIBIN LI...
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