Mr. Mrs. Ms. Fax confirmation or Special Correspondence Payment must be for total number of months you want coverage. Refund of premium will be made only if a written request is received by IMG prior to the effective date of coverage. After that, the premium is fully earned and non refundable. If paying by credit card, I authorize IMG to bill my credit card account for the total charge as specified in Total Premium .
Coverage purchased by credit card is subject to validation and acceptance by credit card company.
If signed as proxy of the Insured, the undersigned warrants their authority and capacity to so act. By acceptance of coverage, the insured ratifies the authority of the signatory to bind Insured.