
TO HELP YOU DECIDE -ANSWERS
TO HELP YOU DECIDE-INSURANCE COVERAGE CHECKLIST
To order coverage:
- Download and print the application for your state:
Alabama, California, Colorado, Florida, Georgia, Illinois,
Maryland, Oregon, Tennessee, Texas, Virginia, Wisconsin
- Review the coverage outlined in the application, then choose a plan and optional coverages
- Calculate your total plan cost. Transfer these figures to the application (pages 4 and 5)
- Answer all questions and sign the application (pages 4 and 5)
- Read the Mandatory Government Notice (page 3)
- Keep pages 1 through 3 for your records
- Mail pages 4 and 5 with a copy of your childcare license or registration and premium payment to:
Day Care Insurance Services
16601 Ventura Boulevard, Suite 500
Encino, CA 91436-4813
Installment Payment Authorization Form (PDF)
AUTOMATIC PAYMENT ARRANGEMENTS FORM