Paying by Credit Card

Paying by Check

(Please note that a credit card will add 3% service fee)

Name Insured

First Name

Last Name

Name on Card

Total Due

$

Email Address

Card Type

Card Number (No dashes or spaces)

Verification Code (3 digit on back)

Expiration

Expiration Year

Billing Address

I authorize Frazier Insurance Agency, Inc. to charge my credit card in the amount listed above for the insurance as requested by me.

Please make all checks out to Frazier Insurance Agency, Inc. and send to our P.O. Box:

Frazier Insurance Agency, Inc.
P.O. Box 1250
Midlothian, VA 23113

Please send all rush payments and overnight checks to our physical location:

Frazier Insurance Agency, Inc.
1602 Rolling Hills Dr, Suite 104
Richmond, VA 23229

For Wire Transfers and ACH Payments, please contact us.