Submit Payment - UIS Georgia

Full Business Name (D/B/A)

Corporation Name

Policy#

Select Insurance Company

Please select the Payment Mode

Name of the Bank

Name on the Account

Routing

Account

Type of Debit/Credit Card

Name on the Account

Debit/Credit Card

Expiration Date

CRV

Card Billing Zip Code

Payment Due Date

Payment Amount:$

Contact Person

Phone

Do you want to upload any document or file ?

(".txt", ".doc", ".docx", ".xls", ".xlsx", ".csv", ".pdf" files only)

Submit Payment Information