Insurance Service Center DePere - Auto Insurance Checklist

Client Name*

First NameLast Name

Email Address

Optional Coverages

Are you interested in...*

	Yes	No	Call Me
Roadside Coverage and/or AAA membership (Approximately $6 per vehicle every 6 months. For higher limits check the "Call Me" box.)
$0 Glass Deductible - Waives your comprehensive deductible in the event of a glass claim. (Approximately 5% of your comp premium.)
Rental Coverage* - Provides $30 per day for a rental car if your vehicle is being repaired due to an accident. Higher limits may be available on request. (Approximately $15 per vehicle every 6 months. For higher limits check the "Call Me" box.)
Loan/Lease (Gap) Coverage* - Pays the difference between your loan or lease and the blue book value of your vehicle. (Approximately $10 per vehicle every 6 months.)
New Parts Coverage* - Company will provide new vehicle parts from the manufacturer (when available) instead of aftermarket or used parts. (Approximately 5% of your comp and collision premium.)
Special/Custom Equipment/Paint Coverage* - Provides coverage for non-factory installed equipment such as custom paint job, truck top, bug shield, stereo equipment, etc. (Price varies by item. If interested in prices, check the "Call Me" box.)
Replacement Cost Coverage* - Replaces your new (previously untitled) vehicle in the case of a total loss.

Questions*

	Yes	No	Call Me
Do you want life or disability insurance to help cover your auto loan payments?*
Do you want to increase your auto liability and/or uninsured/underinsured motorist coverage?
Do you have a vehicle provided by your employer?
If so, broadened coverage should be added to the policy especially if you ever use that vehicle to pull a personal trailer, boat, camper, etc. Would you like us to add this coverage?
Is your vehicle used for delivery, snowplowing, driving for fee (i.e. Uber/Lyft), or have any advertising on it?

Questions*

	Yes, I understand.	I have questions, call me.
I understand I must notify ISC of all drivers in my household or anyone who drives my vehicle on a regular basis. I understand an insurance company may deny a claim if an undisclosed driver is driving my vehicle. Please note: Even students with "temporary license" or drivers with other insurance need to be listed, whether or not they use your vehicle(s). Students away at school should also be listed.

Do you understand there is NO COVERAGE for:

Electronic Devices and personal property in your vehicle are not covered.
Moving vans rented by you are not covered.
Vehicles and Trailers not listed on your policy are not covered.
Vehicles not titled in your name are not covered.
I need to call my agent if I rent a car as there may be gaps in coverage.
I should talk to my agent about any further discounts that may be available to me. (ie, Good Student, At school over 100 miles without a car, AARP, Group Affiliate, etc).
If my vehicle has a salvaged/branded title I need to inform my agent as the coverage may be limited.

Yes, I understand.I have questions, please call me.

*Coverage subject to policy limitations and payable in the event of qualified claims. Subject to underwriting approval.

Comments:

I have personally reviewed the answers above. I understand that this checklist is not meant to imply, in any manner, that these are the ONLY items that may be of concern to me. I understand it is my responsibility to advise Insurance Service Center of any special circumstances or insurance needs I may have, or as my situation changes.

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