NAME OF INSURED
VEHICLE INFORMATION
TOTAL LOSS SETTLMENT ACTUAL CASH VALUE
COMPREHENSIVE $1000.00 DEDUCTIBLE
COLLISION $1,000.00 DEDUCTIBLE
CUSTOM PARTS & EQUIPMENT $3,000 INCLUDED AT NO CHARGE
TRIP INTERRUPTION $400.00
ROADSIDE ASSISTANCE $150.00
AFTER PAYMENT ACCEPTANCE, YOU WILL RECEIVE A REQUEST FOR AN "E" SIGNATURE. UPON EXECUTING "E" SIGNATURE, YOU WILL BE ABLE TO PRINT ALL DOCUMENTS REQUIRED.
Insurance Provided By National General Insurance Company.