Leatherstocking Cooperative Insurance Company

Online Credit/Debit Card Payment

Leatherstocking Cooperative Insurance Company

Policy Number

Insured

Type of Card

Credit Card #

Expiration Date

3 or 4 digit security code on card

Amount of Payment

Name on Credit Card

Street or P.O. Box

Mailing Address:

City

State

Zip Code

Daytime Phone #

Receipt Requested

(receipt will be sent via e-mail if provided)

E-mail Address

This payment is subject to policy provisions and conditions.

Note: If your policy has been cancelled prior to this payment being received payment may not be accepted. Once this payment has been fully processed, it will be reflected in your account status.

YOU MAY ALSO MAKE A CREDIT CARD PAYMENT BY CALLING OUR TOLL FREE # 1-800-886-8048

Enter Security Code