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Policy Info
Start your new policy or update payment info with Vantage Point Risk.
"
*
" indicates required fields
Step
1
of
2
50%
About You
Your Name
*
First Name
*
Last Name
*
Business Name
Business Name
If applicable
Billing Address
Street Address
Address Line 2
City
ZIP Code
Your Email Address
*
Email Address
*
Confirm Email Address
*
Mobile Phone
*
Mobile Phone
*
By entering your phone number you agree to receive text from Vantage Point Risk.
Update or New Policy
*
Update Existing Info
Start New Policy
New Policy Start Date
As Quoted
Specific Date
Date
MM slash DD slash YYYY
Date
Payment Method
EFT
Credit Card
Payment Options
Pay In Full
Monthly Installments (may incur monthly service fee)
Bank Name
*
Bank Name
*
Routing Number
*
Routing Number
*
Account Number
*
Account Number
*
Account Type
*
Checking
Savings
Type
*
Visa
MasterCard
American Express
Discover
Name On Card
*
Name On Card
*
Card Number
*
Card Number
*
Experation Date
*
Experation Date
*
CVV
*
CVV
*
Authorization
*
Yes
I authorize Vantage Point Risk Partners LLC to charge the payment method provided for the payment of insurance policy(s) as proposed. I certify that I am an authorized user of this payment method and agree not to dispute the payment with my financial institution, provided the transaction aligns with the terms indicated in this form. I understand that payment will be processed immediately upon Vantage Point Risk initiating the policy with the carrier, regardless of the policy's effective date.
This field is for validation purposes and should be left unchanged.
This field is for validation purposes and should be left unchanged.
Δ
"
*
" indicates required fields
Step
1
of
2
50%
About You
Your Name
*
First Name
*
Last Name
*
Business Name
Business Name
If applicable
Billing Address
Street Address
Address Line 2
City
ZIP Code
Your Email Address
*
Email Address
*
Confirm Email Address
*
Mobile Phone
*
Mobile Phone
*
By entering your phone number you agree to receive text from Vantage Point Risk.
Update or New Policy
*
Update Existing Info
Start New Policy
New Policy Start Date
As Quoted
Specific Date
Date
MM slash DD slash YYYY
Date
Payment Method
EFT
Credit Card
Payment Options
Pay In Full
Monthly Installments (may incur monthly service fee)
Bank Name
*
Bank Name
*
Routing Number
*
Routing Number
*
Account Number
*
Account Number
*
Account Type
*
Checking
Savings
Type
*
Visa
MasterCard
American Express
Discover
Name On Card
*
Name On Card
*
Card Number
*
Card Number
*
Experation Date
*
Experation Date
*
CVV
*
CVV
*
Authorization
*
Yes
I authorize Vantage Point Risk Partners LLC to charge the payment method provided for the payment of insurance policy(s) as proposed. I certify that I am an authorized user of this payment method and agree not to dispute the payment with my financial institution, provided the transaction aligns with the terms indicated in this form. I understand that payment will be processed immediately upon Vantage Point Risk initiating the policy with the carrier, regardless of the policy's effective date.
This field is for validation purposes and should be left unchanged.
This field is for validation purposes and should be left unchanged.
Δ