Electronic Funds Transfer Payments

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					                                      R.M.I.S.
                         ROBERT MORENO INSURANCE SERVICES
                                P.O. BOX 5185, FULLERTON, CA 92838
                                 PHONE: 714-738-1383 • 213-383-5590

                                                                                  www.RMISmga.com



                “EFT” Electronic Funds Transfer Payments
The EFT payment system is available for nearly all new business downpayments and for all monthly
direct bill and installment bill premiums via our website at www.RMISmga.com. The EFT payment
system allows RMIS to sweep the appropriate and approved funds from your Trust Account rather than
having to write a check.

EFT for Direct Bill/Installment Bill/Agency Bill New Business Applications via RMIS eApp

If your brokerage is signed up for EFT payments, your trust account will be debited for the first month’s
premium plus fees when a Direct Bill or Installment Bill New Business application is submitted via RMIS
eApp. We also have the ability to debit the requested and approved downpayment (usually 25%
minimum) on Agency Bill policies in both Personal Lines and Commercial Lines. RMIS will only sweep
the funds provided the application is eligible and has been issued by RMIS. RMIS binding procedures
must be followed and the original application and forms must be faxed, emailed
(bindrequest@rmismga.com) or mailed accordingly.

Online EFT Payments for Direct Bill and Installment Bill Monthly Premiums

If your brokerage is signed up for the EFT payments, you can apply monthly premium payments online at
www.RMISmga.com via the EFT payment option, in addition to the existing credit/debit card payment
option. The transaction is recorded immediately and a payment receipt is provided.

Using the online payment system is simple for your brokerage. Log in to our website and select “Policy
Center.” After selecting the customer for which payment is to be made, click on the “Make Payment”
link on the left and under the Next Payment Due section of the policy page. Both links take you to the
Secure Online policy payment system. Select the payment option desired (EFT bank sweep or
Credit/Debit card) then simply input the required information and submit the payment.

*All payment transactions are secured using Verisign SSL encryption.*

Getting Started - If your brokerage would like to utilize the EFT process, please fill out the attached
form and fax it to (714) 992-1069 Attn: Marketing Dept.
Please remember to include a voided trust check for the account to be debited. If you have multiple
producer codes, please advise which codes you would like to have debited from the account for which
you are providing the voided check. Once we have set up your brokerage for the EFT process, a
representative will contact you to let you know that you may begin utilizing the EFT payment process.

Please contact our marketing department with any questions that you may have regarding the EFT
payment process.

                          Robert Moreno Insurance Services
                             Providing professional service since 1978.
                                           R.M.I.S.
                           ROBERT MORENO INSURANCE SERVICES
                                    P.O. BOX 5185, FULLERTON, CA 92838
                                     PHONE: 714-738-1383 • 213-383-5590

                                                                                    WWW.RMISMGA.COM

             EFT – Electronic Funds Transfer Agreement

    **Please attach a voided trust check to this form and return both to RMIS**

                 Authorization For Automatic Cash Withdrawals
I, _______________________________________________, give Robert Moreno Insurance Services the
authorization to withdraw the appropriate RMIS money that has been deposited into the brokerage’s trust account.

I further authorize the financial institution named below to accept such automatic deposits to or withdrawals from
my account by Robert Moreno Insurance Services and to automatically credit or debit, as the case may be, such
amounts.

Banking Institution: ______________________________________________

Street Address: __________________________________________________

City, State, Zip: __________________________________________________

Phone Number of Banking Institution: (            ) ________-___________

Please use the following routing and account numbers for each transaction. (Attached is a copy of voided
trust check)

         ___________________________                           ____________________________
         Routing Number                                        Account Number

I understand that I may cancel this authorization at any time. To cancel, I must give written notice to RMIS. My
cancellation will become effective when RMIS receives my written request to cancel and has a reasonable period of
time upon which to process the change.

I further understand that all automatic deposits to or withdrawals from my account under this authorization will be
subject to all rules, regulations, agreements and disclosure statements of the company and the institution governing
accounts and pre-authorized transfers to and from this account.

Brokerage Name __________________________       Producer Code(s)___________
Brokerage Address ______________________________ City ________________ State ___ Zip ______
Authorized By ____________________________

                            Robert Moreno Insurance Services
                                Providing professional service since 1978.
Signature X______________________________       Date ____/____/______




                     Robert Moreno Insurance Services
                        Providing professional service since 1978.