ISC Insurance Services Corporati

ISC Insurance Services Corporation
Premium Payment Centre
Credit card transactions will be converted to USD.
Use the currency converter to determine the approximate amount you will pay in USD.

Payment by Credit or Debit card data collection & authorization

Name and complete address of our Assured

Name and complete Billing Address of cardholder
(If the same as our Assured skip to next box otherwise enter correct information)
Same as Named Assured

Telephone number of cardholder

eMail address of cardholder

The policy number this payment applies to

Bankcard/Credit card type American Express, MasterCard or Visa accepted

Card number (No spaces or dashes) No spaces or dashes

Card security code* * 3 digits on the reverse of MC & Visa cards and 4 digits for Amex

Card expiry date MM/YYYY MM YYYY

Items on your bankcard statement will appear as ISC Insurance Services Corporation.

I hereby authorize ISC Insurance Services Corporation to charge my bankcard or credit card for the amount due in USD. I am aware there is a charge for this service of 3.25% for Visa & MC accounts and 5.25% for American Express. I understand if my cardholder does not authorize this transaction I/we have no insurance and any coverage I/we may have had is cancelled ab initio. I understand and agree no coverage is in force until confirmed in writing by the Insurer.

X
Type cardholder signature in box above and click I AUTHORIZE & AGREE below to complete transaction.

If you have comments or suggestions please enter them here

Card security code*

▼Please refer to the diagrams below to locate the codes on your card▼

Visa & MasterCard
The Card ID is a 3-digit number located on the BACK of your card in the signature field

American Express
The Card ID is a 4-digit number located on the FRONT of your card above the card number

Click here to return to Enter Card Security Code

Name and complete address of our Assured
Name and complete Billing Address of cardholder (If the same as our Assured skip to next box otherwise enter correct information)	Same as Named Assured
Telephone number of cardholder
eMail address of cardholder
The policy number this payment applies to
Bankcard/Credit card type	American Express, MasterCard or Visa accepted
Card number (No spaces or dashes)	No spaces or dashes
Card security code*		* 3 digits on the reverse of MC & Visa cards and 4 digits for Amex
Card expiry date MM/YYYY	MM YYYY
Items on your bankcard statement will appear as ISC Insurance Services Corporation.
I hereby authorize ISC Insurance Services Corporation to charge my bankcard or credit card for the amount due in USD. I am aware there is a charge for this service of 3.25% for Visa & MC accounts and 5.25% for American Express. I understand if my cardholder does not authorize this transaction I/we have no insurance and any coverage I/we may have had is cancelled ab initio. I understand and agree no coverage is in force until confirmed in writing by the Insurer.
X Type cardholder signature in box above and click I AUTHORIZE & AGREE below to complete transaction.

If you have comments or suggestions please enter them here
Card security code*	▼Please refer to the diagrams below to locate the codes on your card▼
Visa & MasterCard The Card ID is a 3-digit number located on the BACK of your card in the signature field		American Express The Card ID is a 4-digit number located on the FRONT of your card above the card number
Click here to return to Enter Card Security Code