Online Renewal of Office insurance for Registered Massage Therapists

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Renew Your Office Coverage Online
* Choose one of the following 2 options:
Ontario residents
Please renew my office contents policy for an annual premium of $297.00 ($250+$25 policy fee + PST)
All other provinces
Please renew my office contents policy for an annual premium of $275.00 ($250 + $25 policy fee)

Note: If you have purchased or need additional coverages above the $25,000 limit click here
* Designates mandatory fields. These MUST be filled in.
Business/Clinic name (if applicable)
First Name	*
Last Name	*
Phone Number with Area Code	*
Fax Number with Area Code
Email Address	*
Verify Email Address	*
Your Web Page WWW.
Clinic Address	*
City	*
Province	*
Postal Code	*
Optional: Please mail my certificate to a different address:.
Mailing Address
City
Province
Postal Code


This office policy is only available to therapists that have their Professional and General Liability insurance with Lackner McLennan.
I do have my liability insurance with Lackner McLennan	I do not have my liability insurance with Lackner McLennan
Optional: Many massage therapists find it convenient to have their office contents policy automatically renewed and paid for each year. If you would like us to bill your credit card each year on April 1st and send you your policy, check yes. If you would like to receive a renewal notice by mail and have the option to pay by cheque, or credit card, check no.
Yes No
If you check yes to have your policy automatically renewed please enter your credit card number and expiry date. BE SURE YOUR CREDIT CARD IS GOOD FOR AT LEAST ONE YEAR (FAQ)
Must be credit card number with no spaces (16 digits), then space and expiry (month year; 4 digits)
Example: 1234123412341234 0209


By submitting this application, you attest that the application has been completed accurately and honestly. You understand that your insurance certificate will provide evidence that you have been added as an individual participant with respect to the coverage and limits of the Master Policy. You understand that the coverage provided by your insurance certificate is subject to all the terms, conditions and exclusions contained in the Master Policy. You further understand that the Insurance Company will rely on the information you have provided in the application. Failure to pay required premiums and/or false statements on this application or subsequent renewals shall void this application and render your insurance coverage null and void, and you may be subject to further legal action for making false statements. I Agree I Disagree
Note: this is just an order form; it does not confirm insurance. If you require immediate documentation please provide your fax number.

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