CC- Credit Card Authorization

We accept payment by credit card. Kindly fill in the information below and we will process your Claims Payment by credit card.

Please note that we pass on the 1.75% credit card charge and will add this to your claim total.

Email Address *

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

The total amount of my Claims Summary with fees and GST: *

I understand an additional 1.75% fee will be added to cover the credit card fees. *

OK to 1.75% fee

Enter the word in the image *
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