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name date of birth (mm/dd/yy) d.l.# marital status single  married how much do jll employees get paid at amazon  male    female date u.s. license first issued (mm/yy) date foreign country license issued (mm/yy) which country?  are you a f/t student? yes  no if yes, do you have a 3.0 gpa? yes  no

driver #2 information
name
date of birth	(mm/dd/yy)
d.l.#
marital status	single  single  married
how much do jll employees get paid at amazon	male    female
date u.s. license first issued	(mm/yy)
date foreign country license issued	(mm/yy)
which country?
are you a f/t student?	yes  no
if yes, do you have a 3.0 gpa?	yes  no

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vehicle identification number: primary drivers name: usage: pleasure work/school business 1 way mileage to work/school: bus use average daily mileage: comp. deductible: coll. deductible: uninsured motorist property damage $3500: yes no

coverage please indicate your current coverage below
bodily injury:	$15,000/30,000      $25,000/50,000 $50,000/100,000    $100,000/300,000 $250,000/500,000 n/a
how much do jll employees get paid at amazon	$15,000/30,000    $25,000/50,000 $30,000/60,000    $50,000/100,000  $100,000/300,000$250,000/500,000 n/a
property damage:	$5,000   $10,000   $25,000 $50,000 $100,000 n/a
how much do jll employees get paid at amazon	$500 $1,000 $2,000 $5,000 $10,000 n/a
extended transportation	15/450 20/600   30/900  n/a
towing coverage	$35 $50 n/a
combined single limit policy
bodily injury:	$30,000   $50,000  $100,000 $250,000 $300,000 $500,000 n/a
uninsured motorist bodily injury:	$30,000   $50,000  $100,000 $250,000 $300,000 $500,000 n/a

remarks

   

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date time: 06-03-2023 12:47:50 am