By signing this form, you authorize nucleus insurance to charge your credit card for the total payment amount specified above. This is a one-time payment for insurance-related services/products.
Non-Refundable Payment Policy:
Due to the nature of this payment for insurance-related services/products, all payments are final and non-refundable.
You acknowledge and agree that no refunds will be issued for any reason, including but not limited to cancellation, changes in circumstances, or dissatisfaction with services/products.
Card Processing Fee Disclosure:
A 4.6% card processing fee will be applied to all payments made using a credit or debit card.
By submitting this form, you acknowledge that this fee is non-refundable and agree to pay the total amount, including the processing fee.
If you wish to avoid this fee, alternative payment methods (e.g., ACH, wire transfer) may be available. Please contact us for details.
Payment Processing: Payments are securely processed through our payment gateway in compliance with PCI DSS standards. Your payment information will not be stored beyond what is necessary for processing the transaction.
Disclosures
No Refunds: By submitting this form, you acknowledge that all payments made to nucleus insurance are final and non-refundable due to the nature of the insurance-related services/products. Card Processing Fee: A 4.6% processing fee applies to all payments made via credit or debit card. This fee is non-refundable and reflects the cost of processing card transactions. Electronic Signature Consent: If submitting this form electronically, you consent to the use of your electronic signature and agree to conduct this transaction electronically. Legal Jurisdiction: This authorization is governed by the laws of the United States. Fraud Warning: Providing false information or unauthorized use of a payment method is subject to legal penalties.
