Downpayment Form
Do you have 630 and up or good prior insurance history? You may qualify for NO DOWNPAYMENT to obtain coverage. Customer must submit payment information along with this sign agreement to execute this contract.
I, ___________________________, am obtaining coverage without a down payment due to my credit worthy with Edmond Consulting Group’s (ECG) preferred vendor or ECG official. I understand that my down payment will be due within 14 days after coverage begin. This is a promissory letter between______________________ (client) and __________________________(ECG’s officer) on ___of______, 20__ in agreement that I will meet my obligation will be met or there will be a $350 penalty that will be payable to Edmond Consulting Group. This form must be signed before receiving temporary cards or policy information. We look forward to provide you upholding our commitment to excellent service.

When signing this agreement electronic, you are still binded to the terms of this agreement.
I agree to this agreement. *
Name *
Your answer
Date *
Your answer
Email *
Your answer
Driver License *
Your answer
Payment Information
There is an $30 application fee. This information will also be used to draft your initial down payment within 14 days which will still allow you another 20 days depending on effective date. All future payments will be automatic draft so please list the date of draft.
Method of payment *
Draft date *
Your answer
Banking Information
Routing Number
Your answer
Account number
Your answer
Credit Card
This is required for application fee.
Card Number *
Your answer
Security Code *
Your answer
Expiration *
Your answer
Billing Zip code *
Your answer
Referral by *
Your answer
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