Billing Request Form

Billing Request (new)

Billing Request Form

Request a change

Please submit the form below. If you’re requesting a change to automatic payment status, your request will be processed in 5 business days. If you need to discuss payment plan options, an American National representative will contact you within 5 business days.

Choose all that apply:

I'm unable to pay my bill and/or would like to be contacted to discuss a revised payment plan

I need to stop my existing automatic payments

I unenrolled in automatic payments (due to COVID-19) and would like to re-enroll

Policy Information

Insured/Owner Name On Policy

Policy Number

Zip Code

Contact Info

Please provide your contact information to help us follow up on your request. If you’re requesting a revised payment plan, someone will contact you within 5 business days to talk through your options.

Email Address

Phone Number (Optional)

Additional comments - Please do not include any personal information like bank accounts or credit card numbers

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Confirm your information

By clicking 'Confirm', you are saying the information provided is accurate to (???).

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American National is a group of companies writing a broad array of insurance products and services and operating in all 50 states. American National Insurance Company was founded in 1905 and is headquartered in Galveston, Texas. In New York, business is written through Farm Family Casualty Insurance Company, United Farm Family Insurance Company, and American National Life Insurance Company of New York, Glenmont, New York. Property and casualty insurance is written through American National Property And Casualty Company, Springfield, Missouri, and its subsidiaries and affiliates. Other products and services referenced in this website, such as life insurance, annuities, health insurance, credit insurance, and pension products, are written through multiple companies. Not all products and services are available in all states. Not all companies are licensed in all states. Each company has financial responsibility only for its own products and services and is not responsible for the products and services provided by the other companies.

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Billing Request Form

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