The items in your welcome packet have been recommended to you as a part of your insurance coverage. You have declined to approve them for inclusion in your program as recommended. 

Your signature is required below acknowledging that the policy and coverage options were recommended and offered to you, but you declined to accept them.

​

Any future losses or claims that fall under these coverage items will not be covered. You acknowledge and agree to hold Weaver Insurance Agency harmless for any future losses or claims that are not covered in your insurance program with our office. You can make changes to your program coverage at any time, but coverage cannot be backdated to cover any prior loss. Let us know if you have any questions or wish to make any changes to your new program before binding coverage.