• Payment Authorization

  • I {personSigning13} authorize All City Insurance, Inc. to charge the Credit Card listed above for the amount indicated.  I understad that all Credit Cards transactions are subject to an additional 3.5% processing fee. 

    Disclamer:

    Payment is not a guarantee of coverage by the insurance company or All City Insurance, Inc. its agents, producers or employees.

  • I {personSigning13} authorize All City Insurance, Inc. to debit the Checking Account listed above for the amount indicated. 

    Disclamer:

    Payment is not a guarantee of coverage by the insurance company or All City Insurance, Inc. its agents, producers or employees.

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  • Should be Empty: