Templates - Auto

Field

Required

Would you like a 6-month or 12-month policy?

❌

Bodily Injury

✅

Property Damage

✅

Are any of these optional coverages important to you?
- Accident Forgiveness
- Minor Ticket Forgiveness
- New Car Replacement
- OEM Parts

❌

[ STATE SPECIFIC COVERAGES ]
This will be based on the state selected and can change state to state

N/A

Comprehensive Deductible

✅

Full Glass Coverage

✅

Collision Deductible

✅

Towing & Labor Coverage

✅

How do you use this vehicle?

✅

Rental Expense

✅

Stated Amount Coverage

❌