Illinois Casualty Company

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Account/Policy/Quote Zip Code *

Business Name *

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Last Name *

Email *

Phone Number *

Address 1 *

Address 2

Zip Code *

City

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ACH

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Authorize a one-time electronic payment by filling in the required fields below and clicking Continue. The opportunity to review the submission will occur on the next screen.

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Authorize a one-time credit card transaction by filling in the required fields below and clicking Continue. Please note that a credit card processing fee will be added at $15.00 per payment if less than $500.00 or 2.5% per payment if greater than or equal to $500.00. The opportunity to review the fee before final submission will occur on the next screen

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CVV *

Expiration Month *

Expiration Year *

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