How to Complete ACORD 75 Additional Interest and Signatures

ACORD 75 Insurance Binder Instructions

NAME & ADDRESS

ACORD 75 Insurance Binder

NAME AND ADDRESS

Enter the complete name and address of any additional interest to this Binder.

TYPE OF INTEREST

Check the check box next to the appropriate type of interest. Use the 4th check box to indicate an interest not listed. Use the space to the right of the 4th check box to add a text description of that interest type.

• MORTGAGEE
• LOSS PAYEE
• ADDITIONAL INTEREST
• OTHER - describe

SIGNATURE

AUTHORIZED REPRESENTATIVE

This space should be signed either by a carrier representative - underwriter - or by a person specifically authorized by the Agency / Carrier contract. This will differ by carrier.

I strongly recommend you do not sign your name unelss you can show the document which grants you this authority.

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