Payable To: Insurance Company Name Amount Due $000.00 Mail to: Brokers Information Address: Line 1 Address: Line 2 Payment Terms Down Payment due at time of binding • It is further understood that flat cancellations cannot be arranged • Finance agreements are not authorized • • •
Payable To: Insurance Company Name Amount Due $000.00 Mail to: Brokers Information Address: Line 1 Address: Line 2 Payment Terms • Down Payment due at time of binding • It is further understood that flat cancellations cannot be arranged • Finance agreements are not authorized • •