ROAD SIDE HELP

NuSurance Towing and Roadside Assistance

Covers - Towing - Labor - Lost Key and RENTAL Reimbursement *

Agent or Location

Your Name:

Mr. Mrs. Ms.

Address:

City:

County:

State:

Zip:

Home Phone:

alt Phone:

e-mail Address:

Vehicle Information REQUIRED! Please Note:

Nusurance Towing and Roadside Assistance is for the CAR NOT the Driver and will only cover the car on file

Year	Make	Model

	VIN Number >>

	VIN Number >>

	VIN Number >>

	VIN Number >>
	* The VIN vehicle Identification number may be found on your registration, Please provide for best rate All persons Living in the house hold must be added or EXCLUDED to the quote!

Plan Information -

NuSurance Towing Plan 15 includes :

Dispatched Roadside Assistance, Towing, up to 15 Miles Lost Key $25 - Rental Reimbursement If car is damaged * $15 per day for 5 Days and FREE MAP SERVICE - NO CLAIMS ARE REPORTED TO INSURANCE COMPANIES

NuSurance Towing 15 Plan- 1 Car, $50 Per Year $50.00 NuSurance NuSurance Towing 15 Plan- 2 Cars, $70 Per Year $70.00
NuSurance Towing 15 Plan- 3 Cars, $85 Per Year $85.00
NuSurance Towing 15 Plan- 4 Cars, $95 Per Year $95.00

NuSurance Towing Plan 20 includes :

Dispatched Roadside Assistance, Towing, up to 20 Miles Lost Key $25 - Rental Reimbursement If car is damaged * $20 per day for 5 Days and FREE MAP SERVICE - NO CLAIMS ARE REPORTED TO INSURANCE COMPANIES

NuSurance Towing 20 Plan- 1 Car, $62.50 Per Year $62.50
NuSurance Towing 20 Plan- 2 Cars, $87.50 Per Year $87.50
NuSurance Towing 20 Plan- 3 Cars, $109.00 Per Year $109.00
NuSurance Towing 20 Plan- 4 Cars, $125.00 Per Year $125.00

Select Plan and we BILL to the email you listed - coverage WILL NOT begin until paid and Binder Issued

Comments

I understand by submitting that Nusurance Towing and Roadside Assistance is for the CAR NOT the Driver and will only cover the car on file. I have checked the VIN number as above .