Fingerhut Safeline PDF Details

Fingerhut Safeline is a top-of-the-line security company that provides comprehensive security services to businesses and organizations of all sizes. Their team of experienced professionals offers a wide range of security solutions that are tailored to meet the specific needs of each client. Fingerhut Safeline is committed to providing superior customer service, and they work closely with their clients to ensure that their safety and security needs are met.

Here is the details about the PDF you were seeking to fill out. It will tell you the amount of time you'll need to fill out fingerhut safeline, what fields you will have to fill in, etc.

QuestionAnswer
Form NameFingerhut Safeline
Form Length2 pages
Fillable?Yes
Fillable fields38
Avg. time to fill out8 min 10 sec
Other namesfingerhut safeline insurance, safeline fingerhut, fingerhut benefit app, safeline fingerhut com

Form Preview Example

6250 Ridgewood Road

St. Cloud, Minnesota 56303

Dear Customer:

You made a wise decision when you decided to enroll in the SafeLine® Account Protection Plus Plan in connection with your WebBank/Fingerhut Credit Account.

On the reverse side of this letter is the SafeLine Benefit Activation Application you requested.

Please complete the Benefit Activation Application and send it back to us with the documentation requested on the form. For unemployment applicants, please send proof of unemployment from your state. Acceptable proof would include a confirmation of unemployment benefits letter from your state, a

check stub, or copies of your bank statements showing the direct deposits from your state unemployment office. For hospitalization applicants, acceptable proof would include a doctor’s statement, or a hospital

statement/bill.

Please return the completed form within 30 days. When we have received all the required information, we will review your request for benefit activation and send you notification confirming the status of your request.

If you have any further questions on this matter, please call Customer Service at 1-800-208-2500, or write to the address below.

Customer Service

SafeLine Account Protection Plus Plan

6250 Ridgewood Rd

St. Cloud, MN 56303

Sincerely,

Fingerhut

Customer Service

7552/

SAFELINE® ACCOUNT PROTECTION PLAN

OFFERED BY WEBBANK C/O FINGERHUT

6250 RIDGEWOOD RD ST. CLOUD, MN 56303

SAFELINE BENEFIT ACTIVATION APPLICATION

Please Circle Claim Type:

Unemployment

Disability

Leave of Absence

Hospitalization

*For unemployment and leave of absence complete contact information and employment sections. **For disability and hospitalization complete ALL sections.

 

NAME AND ADDRESS

 

10 DIGIT CUSTOMER NUMBER

 

 

 

 

 

 

 

 

 

TELEPHONE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I authorize any person, institution or organization in possession of information concerning my medical or employment history including any hospitalization, consultation, diagnosis, treatment or prescriptions, to provide the information requested below to WebBank and furnish Fingerhut with such information including, copies of all employment or medical records. A photocopy of this authorization shall be considered as effective and valid as the original.

 

CLAIMANT’S SIGNATURE

 

SOCIAL SECURITY NUMBER

 

DATE

 

 

 

 

 

 

 

 

 

Employer Name

 

Employer Phone Number

 

 

 

________________________________________________________________________________________________________________________

Employer AddressCity, State, Zip Code

________________________________________________________________________________________________________________________

Employed FromToHours per Week

________________________________________________________________________________________________________________________

Date of Unemployment or Leave of AbsenceLength of Leave of Absence

________________________________________________________________________________________________________________________

Reason for Unemployment or Leave of Absence

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

DOCTOR’S STATEMENT (to be furnished without any expense to SafeLine Account Protection Plan or its affiliates.)

FINDINGS: (Please provide a brief description of the patient’s disabilities or reason for hospitalization.)

IS DISABILITY PERMANENT?

YES NO (circle one)

 

 

CAN PATIENT PERFORM ACTIVITIES OF DAILY LIVING? YES NO (circle one)

 

GIVE EXACT DATES OF DISABILITY OR HOSPITALIZATION (unable to work)

FROM: / /

TO: / /

DATE LAST WORKED

/

/

 

 

“I hereby certify that the above described information is based upon reasonable medical probability, and is true and correct to the best of my knowledge and belief.”

PHYSICIAN’S NAME AND DEGREE ( PRINT NAME)

 

STREET ADDRESS/CITY/STATE/ ZIP CODE

 

 

 

 

 

 

 

 

PHYSICIAN’S SIGNATURE

DATE

 

 

MEDICAL ID NUMBER

TELEPHONE NUMBER

FAX NUMBER

X

 

 

 

 

 

 

 

 

 

/

/

 

 

(

)

( )

FORM MUST BE SIGNED OR STAMPED BY DOCTOR’S OFFICE

How to Edit Fingerhut Safeline Online for Free

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Step 1: The first step should be to click the orange "Get Form Now" button.

Step 2: Now it's easy to manage your safeline from fingerhut. The multifunctional toolbar can help you insert, erase, improve, and highlight content material as well as conduct several other commands.

Prepare the next segments to fill out the template:

safeline application printable fields to fill out

Fill out the STREETADDRESSCITYSTATEZIPCODE, FROMTO, PHYSICIANSSIGNATUREX, DATE, MEDICALIDNUMBERTELEPHONENUMBER, and FAXNUMBER areas with any content that can be requested by the system.

Finishing safeline application printable part 2

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