Billing Profile Update Request

State of California Department of Insurance
Accounting Services Bureau
Accounts Receivable
CDI-178 (REV: 10/2022)

To look up company information, click here.

Help (916) 492-3242 ARBilling@insurance.ca.gov
300 Capitol Mall, Ste 1400 Sacramento CA 95814

Company ID Number

NAIC Number Required for Insurers

Insurer Name

Billing Email

I acknowledge and certify:

This email will not receive invoices until future go-live date *

Invoices will continue to be mailed *

New Billing Address

This address will appear on electronic invoices.

Number and Street Number, Street, or Box Number

Address Line 2 Suite, Unit Number

City

State Value is not selected

Zip Code

Representative of the Company

Signer must be a representative of the Company

Name of Signer

Title of Signer

Phone

Email Address

Signature of Representative

Date

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Designate/Update Primary Billing Address (CDI-178)

Billing Email

New Billing Address

Representative of the Company