to pay on-line please complete the information below
 
Company Name
First Name Initial Last Name
Street
City State ZIP
Phone eMail
 
Amount  + Service Charge   = Total  

POLICY STATEMENTS FOR E-COMMERCE:

  1. DELIVERY POLICY: Payment of a deposit insurance premium for a pending insurance application does not assure that the policy is in effect. Only the insurance company can bind the insurance coverage after underwriting and reviewing the application. Insurance premiums paid online after the application has been approved ("in-force policy") however, will be immediately forwarded to the insurance company and will continue the policy in-force.
     
  2. REFUND POLICY: If the insurance application is declined, the premium will be refunded in full immediately. Refunds of insurance premiums paid for an “in-force policy” (ie. after the insurance application has been accepted by the insurance company), will be refunded in accordance with the refund policies of the insurance company. If the cancellation is made after the effective date of the policy, than there will be some reduction in the refund based on the time for which the policy is in effect.
     
  3. PRIVACY POLICY: Information provided by the applicant for the purpose of obtaining insurance coverage will be given to the insurance carrier by the broker’s office as requested by the carrier’s normal procedures. No other person or entity will have access to this information. The client will have to provide a release for any confidential information to be released to 3rd parties.