54.90.161.130
<?xml version="1.0" encoding="UTF-8"?>
<RegistrationXML>
  <ReferenceId>6198b1b4</ReferenceId>
  <PlanId>2</PlanId>
  <DeductibleAmount>250</DeductibleAmount>
  <MaximumLimit>60000</MaximumLimit>
  <StartDate>10/15/2015</StartDate>
  <EndDate>10/31/2015</EndDate>
  <DestinationPlan>United States</DestinationPlan>
  <NoOfApplicants>1</NoOfApplicants>
  <PersonalInfo>
    <Applicants>
  <Applicant>
    <Firstname>André </Firstname>
    <Middlename/>
    <Lastname>Fontaine</Lastname>
    <Age>68</Age>
    <Dob>12/10/1946</Dob>
    <SportsRider>no</SportsRider>
  </Applicant>
</Applicants>
  </PersonalInfo>
  <DepartureInfo>
    <HomeCountryDepartureDate>10/15/2015</HomeCountryDepartureDate>
  </DepartureInfo>
  <ApplicantAddress>
    <ResidenceAddress>
      <Address1>2361 des Abeilles</Address1>
      <Address2/>
      <Country>Canada</Country>
      <State>Quebec</State>
      <City>Auteuil Laval</City>
      <Postcode>H7K 2C8</Postcode>
    </ResidenceAddress>
    <CitizenshipCountry/>
    <Email>vlviladomat@cavalia.net</Email>
    <Phone>
      <Home>5147773340</Home>
    </Phone>
  </ApplicantAddress>
  <Beneficiary>
    <AdDBeneficiaryName/>
    <AdDBeneficiaryRelationship/>
    <UniqueIdentifierType/>
    <UniqueIdentifierNumber/>
    <IssuingCountry/>
  </Beneficiary>
  <CourierCharges>No</CourierCharges>
  <PaymentMethod>
    <Creditcard>
      <CreditcardType>American Express</CreditcardType>
      <CreditcardNumber>373310856463015</CreditcardNumber>
      <NameonCreditcard>David Latourelle</NameonCreditcard>
      <CreditcardExpirationMonth>7</CreditcardExpirationMonth>
      <CreditcardExpirationYear>2019</CreditcardExpirationYear>
      <CreditcardAmount>102.0</CreditcardAmount>
      <CreditcardCodeNumber>9760</CreditcardCodeNumber>
    </Creditcard>
  </PaymentMethod>
</RegistrationXML>

------------Response---------------
26457f0d
ARS-02-0023564
<?xml version="1.0" encoding="UTF-8"?><RegistrationRes><ReferenceId>6198b1b4</ReferenceId><LoginUrl>https://www.azimuthrisk.com/client_login.php</LoginUrl><PolicyDetails><PolicyNumber>ARS-02-0023564</PolicyNumber><UserName>26457f0d</UserName><Password>26457f0d</Password></PolicyDetails></RegistrationRes>