JELMS Insurance Group - Insurance Billing Forms

Simple Billing Forms

Please select your insurance carrier billing form, once this is done you will be required to enter your name and email address into the “Right Signature Application” then click proceed to document. Fill in the required form areas and submit the form, we will receive the form immediate and process it the current/next business day. If you have any questions about this process please contact us.

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Jelms Billing Form

JELMS Insurance Payment Form

Complete this form for a one time credit card or E-check payment.

MetLife Billing Form

MetLife Expressit Form

MetLife's EFT Authorization form places your MetLife policy on recurring EFT payments.

Travelers Billing Form

Travelers EFT Billing

Travelers's EFT Authorization form places your Traveler's policy on recurring EFT payments.

EMC Billing Form

EMC EFT Billing Form

EMC's EFT Authorization form places your EMC policy on recurring EFT payments.

Safeco Billing Form

SafeCo EFT Billing Form

SafeCo's EFT Authorization form places your SafeCo policy on recurring EFT payments.

Mercury Billing Form

Mercury EFT Billing Form

Mercury's EFT Authorization form places your Mercury policy on recurring EFT payments.