By choosing the "Accept" button, I authorize
Travelers** to enroll me in the recurring payment plan I selected on this form and
to charge my insurance premium for the policy number(s) listed above, including
any applicable service charges, directly to my credit card as I have indicated.
I understand that this is a recurring payment plan which means I authorize Travelers
to continue to charge my insurance premium in this manner for future policy terms
until I provide Travelers with written cancellation. I understand that Travelers
and/or my financial institution can cancel my enrollment at any time. I further
authorize Travelers to make refunds, if any, directly to my credit card when applicable.