Suggested Choice #1 |
| Coverage |
Amount |
Premium |
| Bodily Injury |
300/500 |
$______________ |
| UM |
300/500 |
$______________ |
| PIP |
$10,000 |
$______________ |
| Med Pay |
$20,000 |
$______________ |
| Property Damage |
$50,000 |
$______________ |
| Comprehensive |
w/ $250 Deductive |
$______________ |
| Collision |
w/ $250 Deductible |
$______________ |
| Rental and Travel |
_____________ |
$______________ |
| Towing |
_____________ |
$______________ |
| Other:_____________ |
_____________ |
$______________ |
| Other:_____________ |
_____________ |
$______________ |
Total Premium___________ |
Suggested Choice #2 |
| Coverage |
Amount |
Premium |
| Bodily Injury |
100/300 |
$______________ |
| UM |
100/300 |
$______________ |
| PIP |
$10,000 |
$______________ |
| Med Pay |
$5,000 |
$______________ |
| Property Damage |
$15,000 |
$______________ |
| Comprehensive |
w/ $500 Deductive |
$______________ |
| Collision |
w/ $500 Deductible |
$______________ |
| Rental and Travel |
_____________ |
$______________ |
| Towing |
_____________ |
$______________ |
| Other:_____________ |
_____________ |
$______________ |
| Other:_____________ |
_____________ |
$______________ |
Total Premium___________ |
Your Choice #1 |
| Coverage |
Amount |
Premium |
| Bodily Injury |
_____________ |
$______________ |
| UM |
_____________ |
$______________ |
| PIP (No Deductible!) |
_____________ |
$______________ |
| Med Pay |
_____________ |
$______________ |
| Property Damage |
_____________ |
$______________ |
| Comprehensive |
w/ $___ Deductive |
$______________ |
| Collision |
w/ $___ Deductible |
$______________ |
| Rental and Travel |
_____________ |
$______________ |
| Towing |
_____________ |
$______________ |
| Other:_____________ |
_____________ |
$______________ |
| Other:_____________ |
_____________ |
$______________ |
Total Premium___________ |
Your Choice #2 |
| Coverage |
Amount |
Premium |
| Bodily Injury |
_____________ |
$______________ |
| UM |
_____________ |
$______________ |
| PIP (No Deductible!) |
_____________ |
$______________ |
| Med Pay |
_____________ |
$______________ |
| Property Damage |
_____________ |
$______________ |
| Comprehensive |
w/ $___ Deductive |
$______________ |
| Collision |
w/ $___ Deductible |
$______________ |
| Rental and Travel |
_____________ |
$______________ |
| Towing |
_____________ |
$______________ |
| Other:_____________ |
_____________ |
$______________ |
| Other:_____________ |
_____________ |
$______________ |
Total Premium___________ |
To print sheets you can use, follow these simple instructions. With your mouse, highlight from the end of this paragraph back to the top, including and ending at the title, "Automobile Insurance Shopping: Work-sheets - FLORIDA". Then, right click and Choose "print". In the Print screen, choose "Selection" which appears in the Print Range area, then enter "Print".
If you need legal assistance completing the work-sheets or have any legal questions, please call Jeff, in Jacksonville, Florida (904) 353-9000 or toll free at 1-888-SOUDLAW.
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