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Policy Number: 000001 Division Number: 00001

Statement of premiums for coverage from 02/01/2003 through 02/28/2003 

Previous Amount Due: 1015.30
Payment received prior to 03/19/2003: .00
 
Current Premium: 483.45
Current Adjustments: -44.97
 
Total amount billed 1453.78



For billing questions, call 1-800-659-2223

 
Due Date
Coverage
From
Coverage
Through
Bill
Prepared
Total
Due
Premium
Detail
Premium
Summary
Adjustment
Detail
Adjustment
Summary
February, 2003 02/01/2003 02/28/2003 03/19/2003 1453.78 List List List List

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