Acadia Insurance
BIND as ClosePay through SmartPay/RPM
Submit Forms
Choose the form you need.
Whether you’re looking to get started with Pay As You Go or making an update to your billing information, we’ve made it simple to find and complete the form you need.
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I am a policyholder or a business owner
Start Your Authorization FormIf you are a business owner or policyholder setting up RPM for the first time, you’re in the right place.
What to do:
- To start onboarding with RPM, complete the online authorization form linked below. You will need your workers’ comp policy and payroll information.
- Once your online authorization form is submitted, our team will review your details and contact you to complete your setup process.
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I am an insurance agent or carrier
Start Your Authorization FormPreparing an authorization form for your client?
Agents and carriers can prepare the authorization form on behalf of a policyholder.
What to do:
- Prepare the online RPM authorization form linked below for your client.
- After submitting the online form, you’ll receive a pre-filled PDF and unique link in your email. You can add the PDF to your e-signature packet of choice.
- Have the policyholder review and sign the form.
- Upload the signed form back to RPM using the form on this page.
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Want to update your payment details?
Change Payment MethodUse this form to quickly and securely update your billing information so your premium payments stay accurate and uninterrupted.
Submit Authorization Form
Start your onboarding process with RPM
For insurance agents or carriers:
- Prepare the online RPM authorization form for your client.
- After submitting the online form, you’ll receive a pre-filled PDF and unique link in your email. You can add the PDF to your e-signature packet of choice.
- Have the policyholder review and sign the form.
- Upload the signed form back to RPM using this form.
For policyholders:
- To start onboarding with RPM, complete the online authorization form. You will need your workers’ comp policy and payroll information.
- Once your online authorization form is submitted, our team will review your details and contact you to complete your setup process.
"*" indicates required fields
Submit Payroll Form
Submit your payroll information
Submit your payroll files using this form. If the pay date or pay periods are not listed in the report, please include them manually. Missing information may cause delays in processing.
Prefer a quicker and simpler option?
- With your consent, we can integrate directly with your payroll provider to gather the necessary data. This ensures accurate payroll information, more precise premium calculations, and fewer year-end surprises.
"*" indicates required fields
Carrier Lookup
Authorization for premium remittal listed by carrier
Found your carrier?
Showing 10 out of 108 carriers
Carrier Name
Bind Instructions
Ready to start your onboarding process with RPM?
This form authorizes Reliable Premium Management to begin managing premium remittals for your policy. Once submitted and after your policy is bound, we’ll activate your Pay As You Go services and handle premium payments on your behalf.
For policyholders:
Complete this form to begin your setup with RPM. You will need your workers’ comp policy and payroll information.
For insurance agents or carriers:
Prepare this form on behalf of your policyholder. After submitting, you will receive a pre-filled PDF and a unique link by email. You can add the PDF to your e-signature packet of choice. Have your policyholder review and sign the PDF and return it to us by uploading it through the form on this page.