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PREPAIRED FOR: Mr. & Ms. Hemminger | ||||
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PREPAIRED FOR: Mr. & Ms. Hemminger | ||||
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| June 21, 2000 | PPO | |||
| QUOTE GOOD FOR: 10 Days | POLICY TERM: 12 Months | |||
| NAME | AGE | GENDER | SMOKER | DISCT. | MONTHLY | QUART. | |||||
| Chris,Donna Hemminger | 25/23 | M/F | NO/NO | 23%/23% | $247.85 | $743.55 | |||||
| TOTAL | $247.85 EFT | $743.55 | |||||||||
| $250.00 Deductible | RX card included | ||||||||||
| There is a one time $10.00 non-refundable application fee. | ||||||
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| Make sure to print this page before you continue |
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| customer service: 954.927.0255 |