» Click Here to download the Premium Submission Form.

Due Date:
Premiums are due on the first day of the month of coverage.  If payments are not made within 45 days of the due date, the account is subject to termination without further notice.  Please note that non-payment notices are not required by the policy and, if issued, are to be construed as a courtesy extended by Montgomery Management.

Premium Payment Forms:
All premium payments or adjustments must be accompanied by a Premium Accounting Worksheet.  A worksheet is available for download by clicking the link at the top of this page.  This form is in an Excel format and will perform the necessary calculations, once the pertinent information has been entered.  Customized worksheets are acceptable if they include the following data:

• Coverage period of payment.
• Census by coverage type (single/family).
• Rates by coverage type
• Commission rate and amount being deducted (if applicable).
• Name and phone number of the person preparing the premium worksheet.

Any adjustments must be made within three months of the original payment.  The adjustment should be itemized on a separate premium worksheet containing all the information required for a regular premium payment.

Contact Information
For more information contact Donna Dickinson, Sr. Accountant at (800) 883-1500 (x115) or via email premium@montmgmt.com.

W-9 Forms

Any broker or TPA receiving or withholding commissions, must submit a completed W-9 form to MMC.  To download a copy of the form, please click the link below, or contact Donna Pregler at the above number.  These forms are also available at www.irs.gov.

Click here to download a blank W-9 form.

Please mail the original completed forms to:

Montgomery Management

Attn: Donna Dickinson

Two Valley Square

512 Township Line Road, Suite 110

Blue Bell, PA 19422