CALL CENTER
 800-720-0313

Paper Application

CALIFORNIA INSURANCE BINDER APP.
 Physical Damage Only Program

FAX NUMBER
800-318-3854

Paper Application

    drivers info                                                                                                                                    

    Vehicle Information
    Excluded Vehicles List
    Acura NSX, Corvette, Citroen, Delorean, Dodge Viper, Ferrari, Lamborghini, Maserati, Porsche.
    All Salvage or Foreign imports, vehicles that are not in mass production, Kit cars, Questions call 800-720-0313

    Lien Holder info - finance company
      MINIMUM 30 DAY DEPOSIT PREMIUM AND FEES  
    Comprehensive: $500   Collision Deductible: $500
    A $1000 deductible applies to covered physical damage losses when lower deductible amounts are shown on the Declarations of the Binder.
    The $500 deductible applies only if the vehicle has been repossessed by, or surrendered to, the lienholder and the interest of the lienholder has
    been impaired. Claims submitted by consumer will be paid at insured deductible of $1000.00.       

SIGNATURE ________________________________________________________________________________ DATE__________________________________

Click the button to print the current page.