Update Installment Payment Method Form "*" indicates required fields Student InformationStudent Name* First Middle Last Student ID: Please select which payment authorization you would like to update:* Credit Card Information ACH/EFT Bank Authorization Credit Card InformationCard Type* MasterCard Visa Discover Cardholder Name (as shown on card)* First Middle Last Card Number* Expiration Date* CVV Security Code* Cardholder ZIP Code (from credit card billing address)* ACH/EFT Bank AuthorizationBank Name* Name on Account* First Middle Last Bank Routing Number:* Bank Account Number:* Bank Account Type:* Checking Savings HiddenConsent* By checking this box, I authorize authorize Blue Water Benefits Administrators to charge my account listed above above for U of M Annual Student Health Insurance installment payments. I understand that my information will be securely saved to file for future transactions on my account.*Student Signature*EmailThis field is for validation purposes and should be left unchanged. Return to Main Page
