Checkout
Name *
Email *
Phone *
Purchase Description (Product Name) *
Amount *
$
Card Number *
Expiry Date *
CVC *
I confirm that I am the cardholder of the credit card or account that I provided and authorize [HVBA] to charge the first month's Insurance premium on the date my application is submitted, and I agree to be automatically billed on the calendar day of my effective date each month for the future monthly insurance premium. I understand that in the event my payment declines or is returned, I may be automatically re-charged within 30 days. This authorization will remain in effect until my coverage is cancelled or alternative payment information is provided by contacting the HVBAs SVP of Operations, Sarah Hunt at
shunt@vbassociation.com
. .
I understand that monthly transactions will appear on my bank or credit card account as Voluntary Benefits Association.
I understand that in the first 30 days after enrollment, I can cancel this my insurance plans and receive a full refund, as long as I have not used any benefits.
I understand that if after 30 days from enrollment or after using the program, I may cancel my insurance plans, and my benefits will be terminated at the end of the billing cycle for which I was charged. I, then, will not be charged any further.
I understand that if I cancel my insurance plans or you cannot collect payment on the date payment is due, my membership and benefits.
Pay Now
