Golf

 
Sure-Swing Golf Club Dues Protection Order Form

Purchasing Sure-Swing Golf Club Dues Protection Plan coverage is easy. Simply complete and submit our secure online order form. To purchase by mail print, complete and return the order form with your full payment to Creighton & Company Insurance Brokers Ltd. at 315 Matheson Blvd. E., Mississauga, Ontario, L4Z 1X8 or by fax to 905-890-0100. You can also order by calling our office at 905-890-0090 or toll free at 1-800-813-4450 and asking for Vince Spina.

The fine print:
Coverage is only available for Golf Club Dues purchased in Canada for Canadian golf facilities. You must be between the ages of 18 and 59 to qualify for coverage. Purchase must be made no later than March 31st, 2002 for the 2002 golf season. You must disclose full cost (including taxes) of your golf dues. Minimum premium is $81.00 (including the 8% Provincial Sales Tax).

 PERSONAL INFORMATION (Fields with a red asterisk are required)
Name (First) *
Name (Last) *
Address In Canada: *
 Apt:
City:  *
  		Province: *
  		Postal Code: *
 
Telephone: (Res)  *
  		Telephone: (Bus)
 
 Email: *
 
 Date of Birth: *
 

 COVERAGE INFORMATION
 Name of Golf Club: 
 
 Purchase Date: 
 
Annual Golf Dues (including all applicable taxes)
Premium Calculation: (4% of Golf Dues)
Ontario Sales Tax
Total Amount Due*

 * minimum premium charged is $81.00 (including the 8% Provincial Sales Tax)
 BILL MY CREDIT CARD (Fields with a red asterisk are required)
 Please charge my: *
    		Expiry Date: *
 My Account Number is: *
    		Name of CardHolder *

Note: The secure server will encrypt your information and transmit it using the PGP encryption software. It's the industry standard and among the best software available today for secure e-commerce transactions. It encrypts all of your personal information including credit card number, name, and address, so that it cannot be read as the information travels over the Internet.

 

sure-swing@creightoninsurance.com  |  www.creighton-ins.com