THA COMMERCIAL INSURANCE PAYMENTS

To: Toby Hansen Agency Inc.

COMMERCIAL INSURANCE PAYMENT PAGE

~ o ~

Payer Information

[Required]
[Required]
[Required]
Payment Amount:

Select Payment Method

e-Check

Fee: $1.00

Amount: ~n/d~

Processing time: up to 5 business days

Credit\Debit Card

Fee: 2.9% + 55c

Amount: ~n/d~

Processing time: Instant

~ CHECK  ~
~ ADDRESS ~
~~
~~
~BANK & ACCOUNT~
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~ CARD PAYMENT  ~
[Required]
Your Receipt Pages

Please select the page you want to use to create this receipt

Please choose the page!

Unpaid Items for

$podatak.amount_str INVOICE
Created on: podatak.createdOn_str
Due Date: podatak.dueDate_str
podatak.paymentFor
~ o ~

Please Confirm

Are you sure you want to initiate a payment for:

Very Important! Please double check your e-mail addresses. Invalid addresses will be omitted.

You can add up to 5 additional e-mail addresses separated with comma ( , ) character.
(i.e.: john.doe@mail.net, anna@mail.net,jack.smith@mymail.org)

Very Important! Please enter valid e-mail addresses

Add new Payment/Receipt Item

Please Read Carefully...

Please Confirm

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