AMV Form

AMV Form

This form is programmed to calculate the Annual Mileage so it can be used for annual miles to be rated on an Auto Policy.
Date*

MonthDayYear
Date
Producer Name*
Client Name (Last Name, First Name)*
Policy Number*
Year - Make*
Last 4 of VIN*
1st Odometer Date*

MonthDayYear
Date
1st Odometer Reading*
2nd Odometer Date*

MonthDayYear
Date
2nd Odometer Reading*
Difference in Days*
Difference in Odometer*
Average Miles (per day)*
Annual Miles Calculated*
Current Annual Miles Rated on the Policy*
Difference in Miles
Should be Empty: