Payment form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Full Name *Email *Policy Number/Memo *Phone *Sign up for SMSBy selecting the checkbox, you authorize KS Billing & Associates to send you promotional messages, renewal reminders, payment due alerts, and other important updates via SMS. Msg & data rates may apply. Reply STOP to opt out anytimeBilling Address *Address Line 1City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code* We accept Visa, MasterCard, American Express, and Discover. Card Details *Card NumberMM123456789101112Expiration/YY2526272829303132333435Security CodeAmount *Minimum Price: $10.00Total payable *$0.00A 3% convenience fee will be applied to the total amount for all cards. Total PayA 3% convenience fee will be applied to the total amount for all cards. Is there anything you want us to know? (Optional) Card Authorization Statement: By submitting your payment information, you authorize K S BILLING & ASSOCIATES, INC. to charge your card for the amount indicated for insurance services provided. This payment is non-refundable once processed. You acknowledge that you are an authorized user of this card and understand and agree to our terms of service and refund policy.Submit
