Welcome to Get Benefits Insurance Services escrow form for payments that we receive!

As a rule of thumb, the “Total of Payments to Payee” field should equal the amount due on the GA’s invoice. If the client would like to pay by credit card, our standard credit card transaction fee is 3.1% or 3.6% of the premium. You should include this in the retail broker fee. Here is our standard retail broker fee schedule for surplus lines:

Retail Broker Fee (Surplus Lines Only)
Base Premium less than $2,501$100
Base Premium between $2,501 and $5,000$200
Base Premium between $5,001 and $10,000$300
Base Premium between $10,001 and $15,000$400
Base Premium between $15,001 and $25,000$500
Base Premium between $25,001 and $50,000$750
Base Premium greater than $50,001$1,500
Escrow w/ Credit Cards
Is the Full or Partial Payment Being Processed via Credit Card?
This escrow form pertains to how many invoices?
Payee
Is this policy financed?
Was downpayment collected by finance company?
Payment Method
$
$
(By finance company)
$
(Including downpayment collected)
$
Amount we received not including credit card fees.
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

Maximum file size: 104.86MB

QuickBooks Credit Card Payment

Upon submission, you’ll automatically be redirected to this form if you want to submit another.