Insurance Payment Submission Form

Hello, please fill out and submit the form below. Once we receive your completed form, we will go ahead and send you the invoice via PayPal (You can pay via debit/credit) for the payment option you choose in the form. Once payment is received, we will send the official background check request via our partner Checkr aswell as submit your information to our insurance company. We do not offer any refunds on this payment once it has been submitted.

Insurance Payment Submission Form

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Please select what payment option you choose(Required)

$105 Down Payment

Full $145 Payment

*Please note that the total insurance payment is $145.00. If you choose the $105 down payment, the remaining $40 will come out of your pay when you start teaching lessons with us.

Do you agree and understand that once payment is made and your insurance policy is processed, we cannot refund your payment under any circumstances.(Required)

I Agree & Understand

*Please note that once you submit payment and we submit and process your insurance plan under our general liability policy, we cannot offer any refunds. Reason being is because our insurance company does not allow any refunds once the policy is processed.

Insurance Payment Submission Form

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