CPI Online Enrollment Form

PHYSICAL DAMAGE INSURANCE REQUIREMENT NOTICE

In accordance with the Retail Finance/Lease Installment Agreement, we have the right to require that you obtain and provide evidence of physical damage insurance naming CREDITOR (“CREDITOR”, “us” or “our) as loss payee (“required insurance”) and that the required insurance must be in force during the entire term of your finance/lease agreement. You may obtain required insurance from any licensed insurance agent and/or authorized insurance company of your choice. Failure to obtain the required insurance on your own or to keep it in force consistent with the above, constitutes a default under the finance/lease agreement, which gives CREDITOR the right to repossess your vehicle or to purchase insurance to protect our interest and to charge all costs of that insurance to you. If you do not provide evidence of required insurance, CREDITOR will allow you to satisfy the insurance requirement of the finance/lease agreement by insuring CREDITOR’s interest in your vehicle under our Creditor Placed Insurance (CPI) policy. The cost of this coverage will be charged to you. Other important terms and conditions include the following:

CREDITOR is the Insured. Our CPI policy provides single interest coverage and does not directly protect your interest in the same way as your own insurance would. Claim payments made under our CPI policy will be made to CREDITOR and will be credited to your account balance or used to repair your vehicle at CREDITOR’s discretion. In the event of a covered loss, our CPI policy will pay the lesser of (1) the cost to repair or replace your auto, (2) the actual cash value of your auto or (3) the Outstanding Net Balance of your account on the date of loss. The Outstanding Net Balance means the outstanding account balance less the following: payments more than 90 days past due; unearned insurance, finance and other charges appropriate for the finance/lease contract; and charges and penalties added after the effective date of our CPI policy coverage. The salvage value of the covered auto at the time of loss is deducted from any payment made under our CPI policy. Also, a deductible (as shown below) applies to each loss. The insured auto is described below. In the event of a loss, notify CREDITOR.The premium that will be charged may be more expensive than required insurance purchased by you, and our CPI policy coverage may expire before your finance/lease contract is paid off. The Creditor Insured policy is not considered ‘written in connection’ with the credit transaction as defined in Reg. Z, Truth-in-Lending section 226.4(b)(7) and (8) Licensed insurance agents may receive compensation from part of the premium charged to your finance/lease contract for our CPI policy coverage. You may cancel coverage under our CPI policy at any time by purchasing your own required insurance from an agent of your choice. The unearned portion of the premium, if any, will be refunded to you.

The CPI policy does not provide bodily injury or property damage liability insurance. You must obtain this coverage on your own.

The rates for this insurance are not fixed or approved by the state board of insurance and does not provide you any protection, nor does it fulfill the requirement of any state “financial responsibility”, “no fault”, or “minimum liability insurance” laws, nor does it afford you any personal injury liability, property damage liability, uninsured or underinsured motorists or medical payment coverage and furthermore such insurance protects only the creditor and does not protect your equity in the vehicle described below.

CPI Enrollment

Name*
First Last
Choice of Insurance for Coverage*
- I have obtained required insurance through an insurance agent and/or insurance company of my own choosing and will provide evidence of that insurance before taking possession of my auto.
- I have not obtained required insurance on my own. I request CREDITOR to insure its own interest in my vehicle under their single interest CPI policy and that I will be responsible to pay the cost to CREDITOR of such insurance as documented below.
Agreed*
- By checking here, I agree that I have obtained required insurance through an insurance agent and/or insurance company of my own choosing and will provide evidence of that insurance before taking possession of my auto. In the event that such coverage cancels, expires, or non-renews at any time and I fail to replace such coverage, I understand that CREDITOR, at their sole discretion, may allow me to authorize the addition of my vehicle to their CPI policy to protect their interest.
Agreed*
- I Agree that I have not obtained required insurance on my own. I request CREDITOR to insure its own interest in my vehicle under their single interest CPI policy and that I will be responsible to pay the cost to CREDITOR of such insurance as documented below. I understand that I may purchase my own required insurance at any time and coverage under the CPI policy will be cancelled. I understand that this limited physical damage insurance coverage does not include liability coverage and that I have or will obtain liability insurance from an agent or company of my choice.
Collateral: Year*
Year of the Automobile.
Make*
Model*
Last 6 Digits of VIN*
Loan Number*
Effective Date*
Date Format: MM slash DD slash YYYY
Deductible $*
CPI Cost $*
Monthly Cost.
Agreed*
- I have read and understood this document and acknowledge receipt of a completed copy of this form. I agree that any refund of unearned premium shall be refunded to me.
Following online submissions, a customer service representative will contact you for debit/credit card information. This information is required in order to complete the enrollment process.
Authorization*
- By signing below you authorize dealer to debit entries in the form of Credit Card payments to dealer's account in accordance with said payment schedule. Your payment will be made automatically from your account. If a charge has been initially declined, you authorize the dealer to attempt to re-charge the account at a later date. You may cancel this authorization with written notice. Notice must be received at least ten days prior to due date. For inquiries about credit card transactions please call us at 614-891-9911. You also acknowledge that you received a signed copy of this authorization form.
Signature*
Sign using your computer mouse.
04/28/2024

CPI Online Enrollment Form

PHYSICAL DAMAGE INSURANCE REQUIREMENT NOTICE

CPI Enrollment

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