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Credit Card Authorization

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Authorization Confirmation:

By entering the credit card information herein, you hereby confirm that you provide authorization for Breathe Insurance Solutions to use the above payment method for payment of the policy being applied for, and that the insurance company is authorized to initiate payments from the credit card that you are hereby submitting for premium payments as they become due. Premiums due include but are not limited to premium, policy fees, inspection fees, installment fees or any applicable fees.

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Credit Card Authorization

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