Credit Card Authorization Form

URL

This field is for validation purposes and should be left unchanged.

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CREDIT CARD ACCEPTANCE: I authorize Infinity Property & Casualty Corporation to charge my premium payment for my Classic Collectors auto insurance application to my Credit Card.

Policy / Submission Number

Applicant Name

Signature

Date

Name as it appears on Credit Card if Different than above

Address

Day Phone

Evening Phone

CREDIT CARD INFORMATION:

Card Type

VISA

Master Card

American Express

Credit Card Account #

Expiration Date

Amount