Please use this form to authorize IMIS/GowrieGroup to process a payment on your behalf. This form is secured by SSL technology and additional encryption methods to keep your personal information secure. Payments made by wire transfer are also an option, so, if that is your preference, please submit an inquiry requesting the wire transfer instructions rather than completing this form.


This payments site is to be used for premiums billed by IMIS/Gowrie Group and should not be used for payment of premiums billed directly by your insurance company.

Payer

As it appears in IMIS/GowrieGroup records.
Enter a name if payer is a different person than the client.
Provide a telephone number or e-mail address to use to contact you if there is a problem processing your payment.

Fill the three items below if checking
account or savings account is selected

Checking guide

Fill the three items below if a credit
or debit card is to be charged.

Credit Card Guide

Please only input comments regarding your payment information. Comments regarding your policy should be directed to your customer service representative.

By providing the foregoing information and clicking the Submit Payment button below, I authorize IMIS/GowrieGroup to record a debit entry against my bank or credit card account in the amount specified. I understand that this is a one-time authorization and that no further debits will be entered unless such future entries are explicitly authorized in the Special Instructions. I understand that processing of this debit entry is not a guarantee of any particular insurance or other service and is only a credit on account with IMIS unless such insurance or other service has already been arranged and confirmed. I understand that this payment will be applied to the oldest unpaid charges. Any agreement, authorization, written statement under penalty of perjury, or other record required must be retained as an electronic record that accurately reflects the information in the record, and is capable of being accurately reproduced for later reference, whether by transmission, printing, or otherwise.