EROCYBERSECURITY.COM

ERO Cyber Security

Notice: The Policy for which this Enrollment is made subject to its terms and applies only to Claims made against any of the Insureds during the Policy Period. The Limit of Liability available to pay damages or settlements shall be reduced and may be completely exhausted by amounts incurred as defense costs. Defense costs shall be applied to the retentions. Submission of this Enrollment Form does not guarantee coverage.

Please read carefully and provide all information requested.

Databreach

Your Product

Cyber Liability / Data Breach Protection

$395.00 per year

Cyber Security Enrollment Form

Business Info

Company Name

EFIN Must be 2-10 Digits

EFIN for the Enrolling Business

Address

City

State

Zip

Please Enter Phone with Dashes XXX-XXX-XXXX

Phone Number

Please Enter Phone with Dashes XXX-XXX-XXXX

Fax Number

Please Enter a Valid Email youremail@yourdomain.com

Email Address

Please Enter a Valid Web Address www.youraddress.com

Corporate Website Address

Name of Authorized Representative, Officer of Proprietor

Number of preparers in office

Please Enter a Valid Amount 150000 No Commmas or $ signs

Annual Revenue

Billing Info

Billing First Name

Billing Last Name

Billing Address

Use Above Address

Enter New Billing Address

New Billing Address

New Billing City

New Billing State

New Billing Zip Code

Payment Method

Credit Card

Checking

By signing below, I acknowledge that I am 18 years of age or older; and I agree to enroll in the American Advantage Association; and I wish to purchase the insurance coverage indicated. I understand that coverage will not begin until the effective date shown in the coverage documents delivered to me after enrollment. I acknowledge that I have read, understood and agree to the American Advantage Association Membership Terms and Conditions.. I hereby authorize the American Advantage Association’s administrator, Trupoint Marketing, LLC, to deduct the amount indicated above for the first year billing and to deduct this same amount annually. I understand that this authority will remain in force until I notify my bank or Trupoint Marketing, LLC in writing of its cancellation. I have read, understood and verify the accuracy of the information in the Enrollment Form.

Summary

Ero Cyber Security

Expert Assistance
Crisis Management Services
Breach Coverages
Legal Coverages
Business Coverages

Annual Fees:
Association Membership:	$170.00
Insurance Premium:	$225.00
Total:	$395.00

If you wish to join without purchasing this insurance, please call 855-406-5527