VICTORY COMP IMMEDIATE BIND REQUEST REQUIREMENTS

INFORMATION REQUIRED TO REQUEST BINDING OF COVERAGE:

PLEASE EMAIL COMPLETED/SIGNED DOCUMENTS TO
WCBINDS@BTISINC.COM

OR FAX ALL COMPLETED/SIGNED/SCANNED DOCUMENTS TO

ITEMS REQUIRED
Step 1
Application SIGNED by APPLICANT and BROKER (all pages must be submitted)

Subject To SIGNED by APPLICANT
Step 3
LOSS INFORMATION REQUIREMENTS Loss Warranty Form
can be used in place of loss runs on all accounts under $5,000 in premium (other than contracting risks). Loss runs (4 years currently valued - 90 days) are required on all accounts $5,000 and over in premium and for contracting risks.
Step 4
PAYMENT INSTRUCTIONS
Please forward the AmTrust deposit check to:
AmTrust North America
Attn: Accounts Receivable
P.O. Box 6939
Cleveland, OH 44101-1939
(Please make sure the policy number is on the check to AmTrust)
**Do not collect Down Payment on Direct Debit options**

For credit card payments (down payment only) please contact AmTrust customer service at 877.528.7878 8am-6pm EST.

PLEASE FAX ALL COMPLETED/SIGNED DOCUMENTS TO OR EMAIL COMPLETED/SIGNED/SCANNED DOCUMENTS TO wcbinds@btisinc.com