Payment Plan Change Request

Please complete this form to submit a payment plan change request to PICA. The payment plans available to you include:

2-Pay (50% down payment and 50% due in 90 days)
4-Pay (25% down payment and 3 quarterly equal payments - STATE OF IL ONLY)
5-Pay (25% down payment and 4 payments every other month)
10-Pay (15% down payment and 9 installments monthly) REQUIRES AUTOPAY ENROLLMENT

You can also make a one-time payment to pay in full. Please see the total amount due on your renewal offer and follow instructions to pay the full premium amount due for your policy term.

If you have questions about payments, please review our Payments FAQs page here.

This form is ONLY for your upcoming policy term for your renewal, you cannot change payment plans mid-term.

Please note that finance fees for payment plans will vary by state. Exact fee details will be shown on your revised renewal offer.

First name*

Last name*

State*

Email*

Phone number*

Policy Number (if available)

Payment plan requested*

Payment plan changes will apply to your next renewal. Mid-term changes may not be made.

To set up autopay, please log into your account, choose payments, then Manage Payments to access the Docuphase portal.