Croatian Fraternal Union of America Online Payments

Please fill out this form to submit your payment.

Form may be used to submit all payments with the exception of Canadian policies.
No Annuity/IRA deposits can be accepted.

Refer to your bill to insert the necessary information:

US Policies ONLY – Canadian Policies cannot be accepted by online payment at this time.

All fields marked with an * are required.

Policy Payment

Select the number of the insured to pay:

Information of 1st Insured

First Name of Insured *

Last Name of Insured *

Lodge/Nest *

Payment Frequency * How many months are you paying for?

Division *

Certificate Number * Required if no Date of Birth

Date of Birth * Required if no Certificate Number

Payment Amount ($ USD) for this Certificate * Please enter in USD format (00.00). Please enter numbers and decimal only!!

Information of 2nd Insured

First Name of Insured *

Last Name of Insured *

Lodge/Nest *

Payment Frequency * How many months are you paying for?

Division *

Certificate Number * Required if no Date of Birth

Date of Birth * Required if no Certificate Number

Payment Amount ($ USD) for this Certificate * Please enter in USD format (00.00). Please enter numbers and decimal only!!

Information of 3rd Insured

First Name of Insured *

Last Name of Insured *

Lodge/Nest *

Payment Frequency * How many months are you paying for?

Division *

Certificate Number * Required if no Date of Birth

Date of Birth * Required if no Certificate Number

Payment Amount ($ USD) for this Certificate * Please enter in USD format (00.00). Please enter numbers and decimal only!!

Information of 4th Insured

First Name of Insured *

Last Name of Insured *

Lodge/Nest *

Payment Frequency * How many months are you paying for?

Division *

Certificate Number * Required if no Date of Birth

Date of Birth * Required if no Certificate Number

Payment Amount ($ USD) for this Certificate * Please enter in USD format (00.00). Please enter numbers and decimal only!!

Miscellaneous Funds Payment Amount ($USD) if Applicable Miscellaneous Funds (ie. Loan/Lien, Single Premium Installment, Juvenile Term $10,000 to $25,000 Upgrade). If completing the Juvenile Term Upgrade please apply full $27 amount in Miscellaneous Funds field.

Comments Please specify where the Miscellaneous Funds are to be applied.

Subtotal Amount: $0

Payment Processing Fee: $0

Total Amount: $0