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{{Insurance.Name}}

{{wizard.Name}}

{{item.Title}}

Coverage Type Limit of Liability Retention Premium
Directors and Officers {{Variables.limit | currency:"$"}} {{Variables.selectedretention| currency:"$"}} {{Variables.DOPremium | currency:"$"}}
Employment Practices {{Variables.limit | currency:"$"}} {{Variables.selectedretention| currency:"$"}} {{Variables.EPLIPremium | currency:"$"}}
Fiduciary {{Variables.limit | currency:"$"}} {{Variables.selectedretention | currency:"$"}} {{Variables.FLIPremium | currency:"$"}}
{{discount.OnlineDescription}} {{discount.OnlineDiscount}}% {{ Variables.Discounts | currency:"$ "}}
Premium Subtotal {{ Variables.SubTotal | currency:"$ "}}
Taxes {{Variables.StateTaxDescription}} {{Variables.StateTaxRate*100 | number :2}}% {{Variables.SubTotal*Variables.StateTaxRate | number :2 | currency:"$"}}
Taxes {{Variables.CityTaxDescription}} {{Variables.CityTaxRate*100 | number :2}}% {{Variables.SubTotal*Variables.CityTaxRate | currency:"$"}}
Total {{ Variables.Total | currency:"$"}}
VISA Accepted Mastercard Accepted Discover Accepted
Shopping is always safe and secure
Security Transaction

Payment Information

{{Purchase.Valids.CardType.message}}
{{Purchase.Valids.NumberCard.message}}
{{Purchase.Valids.CardName.message}}
{{Purchase.Valids.Month.message}}
{{Purchase.Valids.Year.message}}
{{Purchase.Valids.SecurityCode.message}}

Billing Address

Address City Zipcode State
{{Variables.address}} {{Variables.address2}} {{Variables.city}} {{Variables.zipcode}} {{Variables.state}}
Address City Zipcode State
{{Purchase.Valids.Address1.message}} {{Purchase.Valids.City.message}} {{Purchase.Valids.Zip.message}} {{Purchase.Valids.State.message}}

Total: $ {{Variables.Total | number:2}}

Important

IMPORTANT TO KNOW:

Submit
Message:{{Purchase.Result.Message}}
Message:{{Purchase.Result.Message}}
Premium 1 Premium 2 Premium 3
{{Variables.Premium01 | currency:"$"}} {{Variables.Premium02 | currency:"$"}} {{Variables.Premium03 | currency:"$"}}
Premium Subtotal {{ Variables.SubTotal | currency:"$ "}}
Taxes {{Variables.StateTaxDescription}} {{Variables.StateTaxRate*100 | number :2}}% {{Variables.StateTaxTotal | number :2 | currency:"$"}}
Taxes {{Variables.CityTaxDescription}} {{Variables.CityTaxRate*100 | number :2}}% {{Variables.CityTaxTotal | currency:"$"}}
Total {{ Variables.Total | currency:"$"}}

Payment Info

E-mail Policy Documents To Client
{{Purchase.Valids.CheckAmount.message}}

Email Invoice to client
Has binding conditions?
Pending reason
Pend template

Select a reason

Please be advised that the payment submitted with your application was insufficient.
Please send the additional amount owed: $

Note: Please send a check or money order. You may pay by Visa or MasterCard over the phone, if the amount owed is $30.00 or more.
Please contact our office to clarify your staff.
Please contact our office to clarify your occupation and/or employment category.
Note: Please complete the attached qualification questions and/or signature field that were left blank on your application. (Qualification questions will be added into the PDF and Email)
E-mail pending reason to client
Submit

Rates Table

Showing 6 of 10 levels. Click here for show all levels.

Coverage / Level 1 2 3 4 5 6 7 8 9 10
{{level.NewColumn}} ${{level.Level1}} ${{level.Level2}} ${{level.Level3}} ${{level.Level4}} ${{level.Level5}} ${{level.Level6}} ${{level.Level7}} ${{level.Level8}} ${{level.Level9}} ${{level.Level10}}
Please select your desired coverage level by clicking one of the following radio buttons.

Renewing Customers

Do you have a current Professional Liability Insurance Policy for Life Coaches with Philadelphia Insurance Company?

Yes No

Please enter your policy number or email address

Searching...

Your entry does match a record in our system:

  • Policy Number: {{userFound.PolicyNumber}}
  • Email address: {{userFound.Email}}
  • Current Retroactive date: {{userFound.RetroactiveDate}}
  • Current Effective date: {{userFound.EffectiveDate}}
Please proceed to complete remaining information in order to renew your policy.

We’re sorry, but your entry does not match a record in our system.
Please contact us at 800-875-1911 to retrieve your policy information.

Searching...

We’re sorry, but your entry does not match a record in our system.
Please contact us at 800-875-1911 to retrieve your policy information.

Payment Information

*Card Type: {{Purchase.Valids.CardType.message}}
*Card Number: {{Purchase.Valids.NumberCard.message}}
Security Code Shopping is always safe and secure
*Expires On:
{{Purchase.Valids.Year.message}} {{Purchase.Valids.Year.message}}
*Security Code: What is this? Security Code {{Purchase.Valids.SecurityCode.message}}
*Name on Card: {{Purchase.Valids.CardName.message}}
Gross Payment
Net Payment
Total: {{(!Variables.IsGrossPayment ? 0.80*Variables.TotalPremium + Variables.TotalTax + (Variables.Fee ? Variables.Fee : 0) : Variables.Total) | currency}}

Billing Address

Same as Insured:

{{Variables.orgName}}
{{Variables.address + ","}} {{Variables.address2}}
{{Variables.city + ","}} {{Variables.state}} {{Variables.zipcode}}

*Street Address 1: {{Purchase.Valids.Address1.message}} Street Address 2:
*City: {{Purchase.Valids.City.message}} *State: {{Purchase.Valids.State.message}}
*Zip Code: {{Purchase.Valids.Zip.message}}

Message:{{Purchase.Result.Message}}
Message:{{Purchase.Result.Message}}
E-mail Policy Documents To Client
Send Decline Reason
E-mail decline reason to client
Submit

{{question.ErrorMessage}}

{{question.ErrorMessage}}
{{row.MultiAnswerLabel}} Review errors Remove
  • {{question.QuestionDisplay}}
    {{question.ErrorMessage}}
{{wizard.Name}}

{{item.Title}}

Coverage Type Limit of Liability Retention Premium
Directors and Officers {{Variables.limit | currency:"$"}} {{Variables.selectedretention| currency:"$"}} {{Variables.DOPremium | currency:"$"}}
Employment Practices {{Variables.limit | currency:"$"}} {{Variables.selectedretention| currency:"$"}} {{Variables.EPLIPremium | currency:"$"}}
Fiduciary {{Variables.limit | currency:"$"}} {{Variables.selectedretention | currency:"$"}} {{Variables.FLIPremium | currency:"$"}}
{{discount.OnlineDescription}} {{discount.OnlineDiscount}}% {{ Variables.Discounts | currency:"$ "}}
Premium Subtotal {{ Variables.SubTotal | currency:"$ "}}
Taxes {{Variables.StateTaxDescription}} {{Variables.StateTaxRate*100 | number :2}}% {{Variables.SubTotal*Variables.StateTaxRate | number :2 | currency:"$"}}
Taxes {{Variables.CityTaxDescription}} {{Variables.CityTaxRate*100 | number :2}}% {{Variables.SubTotal*Variables.CityTaxRate | currency:"$"}}
Total {{ Variables.Total | currency:"$"}}
VISA Accepted Mastercard Accepted Discover Accepted
Shopping is always safe and secure
Security Transaction

Payment Information

{{Purchase.Valids.CardType.message}}
{{Purchase.Valids.NumberCard.message}}
{{Purchase.Valids.CardName.message}}
{{Purchase.Valids.Month.message}}
{{Purchase.Valids.Year.message}}
{{Purchase.Valids.SecurityCode.message}}

Billing Address

Address City Zipcode State
{{Variables.address}} {{Variables.address2}} {{Variables.city}} {{Variables.zipcode}} {{Variables.state}}
Address City Zipcode State
{{Purchase.Valids.Address1.message}} {{Purchase.Valids.City.message}} {{Purchase.Valids.Zip.message}} {{Purchase.Valids.State.message}}

Total: $ {{Variables.Total | number:2}}

Important

IMPORTANT TO KNOW:

Submit
Message:{{Purchase.Result.Message}}
Message:{{Purchase.Result.Message}}
Premium 1 Premium 2 Premium 3
{{Variables.Premium01 | currency:"$"}} {{Variables.Premium02 | currency:"$"}} {{Variables.Premium03 | currency:"$"}}
Premium Subtotal {{ Variables.SubTotal | currency:"$ "}}
Taxes {{Variables.StateTaxDescription}} {{Variables.StateTaxRate*100 | number :2}}% {{Variables.StateTaxTotal | number :2 | currency:"$"}}
Taxes {{Variables.CityTaxDescription}} {{Variables.CityTaxRate*100 | number :2}}% {{Variables.CityTaxTotal | currency:"$"}}
Total {{ Variables.Total | currency:"$"}}

Payment Info

E-mail Policy Documents To Client
{{Purchase.Valids.CheckAmount.message}}

Email Invoice to client
Has binding conditions?
Pending reason
Pend template

Select a reason

Please be advised that the payment submitted with your application was insufficient.
Please send the additional amount owed: $

Note: Please send a check or money order. You may pay by Visa or MasterCard over the phone, if the amount owed is $30.00 or more.
Please contact our office to clarify your staff.
Please contact our office to clarify your occupation and/or employment category.
Note: Please complete the attached qualification questions and/or signature field that were left blank on your application. (Qualification questions will be added into the PDF and Email)
E-mail pending reason to client
Submit

Rates Table

Showing 6 of 10 levels. Click here for show all levels.

Coverage / Level 1 2 3 4 5 6 7 8 9 10
{{level.NewColumn}} ${{level.Level1}} ${{level.Level2}} ${{level.Level3}} ${{level.Level4}} ${{level.Level5}} ${{level.Level6}} ${{level.Level7}} ${{level.Level8}} ${{level.Level9}} ${{level.Level10}}
Please select your desired coverage level by clicking one of the following radio buttons.

Renewing Customers

Do you have a current Professional Liability Insurance Policy for Life Coaches with Philadelphia Insurance Company?

Yes No

Please enter your policy number or email address

Searching...

Your entry does match a record in our system:

  • Policy Number: {{userFound.PolicyNumber}}
  • Email address: {{userFound.Email}}
  • Current Retroactive date: {{userFound.RetroactiveDate}}
  • Current Effective date: {{userFound.EffectiveDate}}
Please proceed to complete remaining information in order to renew your policy.

We’re sorry, but your entry does not match a record in our system.
Please contact us at 800-875-1911 to retrieve your policy information.

Searching...

We’re sorry, but your entry does not match a record in our system.
Please contact us at 800-875-1911 to retrieve your policy information.

Payment Information

*Card Type: {{Purchase.Valids.CardType.message}}
*Card Number: {{Purchase.Valids.NumberCard.message}}
Security Code Shopping is always safe and secure
*Expires On:
{{Purchase.Valids.Year.message}} {{Purchase.Valids.Year.message}}
*Security Code: What is this? Security Code {{Purchase.Valids.SecurityCode.message}}
*Name on Card: {{Purchase.Valids.CardName.message}}
Gross Payment
Net Payment
Total: {{(!Variables.IsGrossPayment ? 0.80*Variables.TotalPremium + Variables.TotalTax + (Variables.Fee ? Variables.Fee : 0) : Variables.Total) | currency}}

Billing Address

Same as Insured:

{{Variables.orgName}}
{{Variables.address + ","}} {{Variables.address2}}
{{Variables.city + ","}} {{Variables.state}} {{Variables.zipcode}}

*Street Address 1: {{Purchase.Valids.Address1.message}} Street Address 2:
*City: {{Purchase.Valids.City.message}} *State: {{Purchase.Valids.State.message}}
*Zip Code: {{Purchase.Valids.Zip.message}}

Message:{{Purchase.Result.Message}}
Message:{{Purchase.Result.Message}}
E-mail Policy Documents To Client
Send Decline Reason
E-mail decline reason to client
Submit

{{question.ErrorMessage}}

{{question.ErrorMessage}}
{{row.MultiAnswerLabel}} Review errors Remove
  • {{question.QuestionDisplay}}
    {{question.ErrorMessage}}


{{SubmitConfirmation.Header}}

{{SubmitConfirmation.Body}}

Quote Number: {{LogWF.QuoteNumber}}

Policy Number: {{LogWF.PolicyNumber}}