Thank you for choosing Assurant.
Selecting an insurance provider is an
important decision and we’re glad you’ve entrusted Assurant to provide you
with this valuable service.
Your application has been submitted. If you opted to receive your policy by
mail, you should receive it within 10 business days; otherwise, you should
receive your policy within 3-5 business days to the email address provided.
Should you have any questions regarding your coverage please call us at 1-
800-432-8612, Monday through Friday from 8 a.m. to 8 p.m. ET. You may also
email us at rentersmail@[Link].
IMPORTANT: Please add rentersmail@[Link] to your list of safe
senders, to ensure proper delivery of your policy.
Assurant now offers 24/7 online services to manage your policy, get proof of
insurance, make a payment, and much more. Once you receive your policy
simply log on to [Link].
This confirmation of coverage is issued as a matter of information only and
confers no rights upon the holder. This confirmation of coverage does not
affirmatively or negatively amend, extend, or alter the coverage afforded by
the insurance policy.
APPLICATION NUMBER
REN462214700
American Bankers Insurance Company of Florida
11222 Quail Roost Drive, Miami, FL 331576596 • 3052532244
APPLICATION NUMBER
REN462214700
American Bankers Insurance Company of Florida
11222 Quail Roost Drive, Miami, FL 331576596 • 3052532244
RENTERS INSURANCE APPLICATION
FLORIDA
APPLICANT'S NAME AGENT CODE
BRITNEY WEST 7DK0732
ADDITIONAL INSURED INTERESTED PARTY
JARRETT PRYOR INSURANCE TRACKING
APPLICANT'S INSURED ADDRESS AND UNIT/APARTMENT NUMBER INTERESTED PARTY MAILING ADDRESS
1204 ORANGE BLOSSOM CIR APT 304 PO BOX 100513
CITY/STATE/ZIP CODE CITY/STATE/ZIP CODE
AUBURNDALE, FL 33823 FLORENCE, SC 29502
MAILING ADDRESS TYPE OF DWELLING
SAME AS ABOVE APARTMENT/CONDO DORMITORY OR STUDENT
CITY/STATE/ZIP CODE TOWNHOUSE/DUPLEX/TRIPLEX HOUSING
SAME AS ABOVE SINGLE FAMILY HOME
REQUESTED COVERAGE EFFECTIVE DATE THE LEASE IS EFFECTIVE TODAY
06 / 06 / 2024 Yes No Not Applicable
APPLICANT'S PHONE NUMBER E-MAIL ADDRESS
(813) 426-2106 BWEST23@[Link]
SELECTED COVERAGES:
Personal Property Coverage $ 15,000
Replacement Cost Coverage Yes No
$ 2,500 Sewer/Drain Backup Coverage with $ 250 deductible Yes No
$ 15,000 Identity Fraud Expense Coverage with $ 100 deductible Yes No
Pet Damage Coverage Yes No
Water Damage Liability Yes No
In addition to Personal Property Coverage, I understand the plan includes $ 100,000 Personal Liability, $ 1,000 Medical Payments per
Person to Others, $ 500 Property Damage to Others, and a $ 250 deductible will be applied to personal property coverage. This
policy provides only limited coverage for certain classes of property.
TERM OF COVERAGE: 1 Year
Total Annual Premium $ 162.59
* Payment Plan Option:
Selected Payment Plan: Initial Payment: Installment Payment:
11-PAY $27.11 $16.55
*Payment Plan Options are available for all payment methods. If installment payment plan is chosen, a $ 3.00 service fee is included in the
amounts shown.
AUTHORIZE YOUR PAYMENT METHOD:
PAYMENT METHOD:
Please note: You hereby authorize us to make automatic, recurring charges to the credit card/financial institution selected below, and, if necessary,
initiate adjustments for any transaction credited/debited in error. Your recurring charge will remain in effect until we receive notification from you to
terminate.
N/A 7DK0732 LPC 284503 Thu Jun 06 06:52:18 PM EST 2024
1. Credit Card:
I hereby authorize the necessary premium(s) to be charged to my credit card account selected below for the coverage I have selected.
A1035APC1113
Charge my Credit Card EXP. DATE 05 / 2029
Discover Card® CREDIT CARD NUMBER
1. Credit Card:
I hereby authorize the necessary premium(s) to be charged to my credit card account selected below for the coverage I have selected.
Charge my Credit Card EXP. DATE 05 / 2029
Discover Card® CREDIT CARD NUMBER
MasterCard®
American Express® * * * * * * * * * * * * 8 7 6 7
VISA®
2. Automatic Funds Withdrawal:
I hereby authorize the necessary premium(s) to be deducted from my client name bank account for the coverage I have selected.
Checking/Savings account (Your routing number can be found at the bottom of your check located in between colons.)
ROUTING NUMBER ACCOUNT NUMBER
3. Check/money order is enclosed for the premium amount selected.
Make check payable to American Bankers Insurance Company of Florida.
FRAUD NOTICE
Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false,
incomplete, or misleading information is guilty of a felony of the third degree.
COMPLETE AND SIGN:
By typing my full name below as it appears on my account to be billed, I request enrollment in Renters Insurance and authorize the billing of the cost of
the insurance to my account to be billed. I agree to the use of electronic enrollment and intend the use of the electronic signature that follows to evidence
my consent of this enrollment.
I consent to entering into this insurance transaction electronically via the Internet. I also consent to be notified by e-mail at the indicated e-mail address
regarding this insurance, including the status of my insurance application.
APPLICANTS ELECTRONIC SIGNATURE APPLICATION DATE
BRITNEY WEST 06 / 06 / 2024
AGENTS NAME (IF APPLICABLE) AGENTS NUMBER (IF APPLICABLE)
N/A
N/A 7DK0732 LPC 284503 Thu Jun 06 06:52:18 PM EST 2024
A1035APC1113