Questionnaire Payment

To protect your financial privacy, we will only accept payments (for immediate sale) through paypal.

The SafeAssure Questionnaire is $20. Please click on the "Pay Now" button below in order to make your payment. Once your payment has been completed you will be directed to the questionnaire page.

Note: If you cannot pay through Paypal please contact SafeAssure at 1-800-920-SAFE or 1-800-920-7233 for alternative payment options. Using payment other than Paypal may delay questionnaire availability and completion.