For more Information email: Accounting_West@rpsins.com Enter Your Payment Information: Please complete all required fields & use "Text Fields" to describe your payment. If further description is needed, please send separate email to Accounting_West@rpsins.com. Required fields are shown in bold Customer Number � Customer# as shown on statement (See your invoice, it starts with A0######) Agency Name (Please refrain from using special characters when entering the Agency Name. Use AND for & and PLUS for +) Payment entered by (Contact: First Name, Last Name) Contact Telephone Number - - Description of your payment Optional description field Policy/Invoice Amount Policy/Invoice Amount 1) 2) 3) 4) 5) 6) 7) 8) 9) 10)