VEHICLE SCHEDULE
Date (MM/DD/YYYY):
AGENCY:
CARRIER:
NAIC CODE:
POLICY #:
EFFECTIVE DATE:
INSURED:
VEH #:
YEAR:
MAKE:
BODY:
TYPE: PPSPECCOML
SYM/AGE:
COMP/OTC:
COLL:
MODEL:
V.I.N.:
STREET:
CITY:
COUNTY:
STATE:
ZIP:
LIC STATE:
TERR:
GVW/GCW:
CLASS:
SIC:
FACTOR:
SEAT CP:
RADIUS:
FARTHEST TERM:
COST NEW:
USE:
Pleasure Farm Retail Service For Hire
COVERAGES:
Liability Med Pay Uninsured Motorist
DEDUCTIBLES:
AA $
ST AMT $
COMP/OTC: $