Key Benefits Insurance Agency, Inc.
21700 Northwestern Highway, Suite 110, Southfield, MI 48075
Phone: (248) 440 6640   Fax: (248) 440 6650
Online Payment Center
 
Pay your premiums using our convenient and secure payment form 

Transactions on the site are protected with 256-bit Secure Sockets Layer encryption.

By completing the form below, you herby authorize Key Benefits Insurance Agency, Inc. to charge your credit card for the total amount due at the regular interval that you specify.  You understand that US cardholders will be charged an additional 2.15% + 18c per transaction and International card holders will be charged 4.14% + 18c per transaction.  American Express card holders may be charged an additonal fee.  You should be aware of how much you are going to be billed before completing this form.  To find out how much your bill amounts to, you can call (248) 440 6640 ext. 107.  You may cancel this recurring billing at any time by contacting Key Benefits.

All fields are required

Name: *
Address: *
City: *
State: *
Zip/Postal Code: *
Country: *
Phone Number: *
Email Address: *
Name on Credit Card: *
Billing Zip Code: *
Card Type: *
Card Number: *
Expiration Date: *
CVV Code (What's this?): *
Reccurance: *
Day of month to charge card: *
Amount ($US): *

 

                                    

Copyright . Key Benefits Insurance Agency Inc. All rights reserved.