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Purchase Adult Sports Protection Plan

Instructions:
Please enter the information below to complete the application for the Adult Sports Insurance Protection Plan. Once you have entered the required information click the button below 'Continue to Payment' and you will be brought to the payment gateway. Please call Westpoint Insurance toll-free (800) 318-7709 if assistance is required with this form.

All highlighted fields are required to continue.

Premium Computation
In order to apply for the General Liability Insurance, you must first apply for the Accident Medical Insurance (see below).


To purchase Baseball or Softball insurance for adult teams please complete the Baseball/Softball online form.
Policy Term:      
For annual rates please complete a Quote Request or call (800) 318-7709 to recieve a custom quote.

Mandatory Accident Medical Premium Calculation



= Sub-Total (Minimum of $150)

General Liability Premium Calculation

Requires Accidental Medical Insurance above completed first.


= Sub-Total (Minimum of $250)

Additional Insured's (Request for certificate of insurance)

Requires General Liability Insurance above completed first.


= Sub-Total

Optional Coverage

Hired and Non-Owned Automobile Liability

Information

Dishonesty Bond

Information

Contents/Sports Equipment/Inland Marine Coverage

Information

Select your coverage:

=Grand Total

(Includes $20 certificate license fee.)

Are you a new Customer?
Are you a current customer requesting a Renewal Policy?


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Does your organization utilize a waiver system?
Does your organization have a risk management plan?

Have you had any losses?

Does the property where you are conducting the activity require a Certificate of Insurance (additional insured)?
List additional insured name(s) and address(es)


   


   


   



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Premium is fully earned on the effective date of coverage. No pro-rata refunds will be made. Cancellation requests prior to the effective date must be in writing and subject to a minimum cancellation fee of $75.00. I understand and agree that (a) if this application is accepted by the Company, coverage will begin on the date of acceptance or the date requested in the application, whichever is later, subject to payment of the required premium; and (b) Premium computation is subject to audit. Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

Please check the box to verify and agree that the information provided herein is
true and complete.
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