	Gothic Insurance Brokers Ltd Gothic House Station Rd, Old Harlow Essex CM17 0AP Tel – 01279 429024 Fax – 01279 433383 Email – enquiries@gothicinsurance.com

or call

Authorised & Regulated
by the Financial
Service Authority
Firm Number: 300031

Payment page

Please use the form below to make a full or part payment towards your insurance premium. Payments are secure and administered by SECpay.

NB: Cover is NOT guaranteed until you receive confirmation of payment via email.

Payment
Broker Reference: 10-digit reference can be found on the first page of your letter
Client name:
Telephone:
Email:
Comments: E.g. "payment for renewal of Ford Fiesta reg T999 AAA"
Amount: E.g. enter £100 as '100.00' & £199.99 as '199.99'