PRODUCER QUOTE FORM
McNabb Insurance Services
INSTALLMENT PAYMENT PLAN - 20% DOWN AND 11 MONTHLY PAY
for COM Policy / Quote # TBA
Producer Abc Ins Svcs
McNabb UW Colleen
Insured Name John Smith
Annual Premium $ 4,539.00
Policy Fee $ 100.00
DMV filing Fee $ 75.00
ICC filing Fee $ -
Effective Date 2/28/2010
Collect from insured (20% plus fees) $ 1,082.80
Retain commission $ (453.90)
Send to McNabb $ 628.90
Monthly Installment for 11 Months $ 385.56
Premium $ 378.00
Service Fees $ 7.56
First Insured Installment Due Date 3/28/2010
* 20% Down payment includes a 'Deposit' amount of $526.8
** Monthly Installments include a 2% Service Charge, total of $83.16
McNabb Insurance Services
Monthly Installment Payment Plan
Producer Abc Ins Svcs
Insured Name John Smith
for COM Policy / Quote # TBA
Effective Date 2/28/2010
Annual Premium $ 4,539.00
Policy Fee $ 100.00
DMV filing Fee $ 75.00
ICC filing Fee $ -
Initial Payment
Deposit $526.80
Filing Fee $75.00
Policy Fee $100.00
1st Payment $381.00
Due at inception (20% plus fees) $1,082.80
Monthly
Payment Date Due Premium Fee Amount Due
1 3/28/2010 $ 378.00 $ 7.56 $ 385.56
2 4/28/2010 $ 378.00 $ 7.56 $ 385.56
3 5/28/2010 $ 378.00 $ 7.56 $ 385.56
4 6/28/2010 $ 378.00 $ 7.56 $ 385.56
5 7/28/2010 $ 378.00 $ 7.56 $ 385.56
6 8/28/2010 $ 378.00 $ 7.56 $ 385.56
7 9/28/2010 $ 378.00 $ 7.56 $ 385.56
8 10/28/2010 $ 378.00 $ 7.56 $ 385.56
9 11/28/2010 $ 378.00 $ 7.56 $ 385.56
10 12/28/2010 $ 378.00 $ 7.56 $ 385.56
11 1/28/2011 $ 378.00 $ 7.56 $ 385.56
If the above installment payment plan is selected, the insured must sign the
attached acknowledgement form.
In any case, the down payment should be forwarded upon binding. Thank you.
Date: ########
Insured: John Smith
Policy Number: TBA
Dear Client:
Thank you for selecting the installment plan, offered by McNabb Insurance Services, as
the payment method for your policy with Topa Insurance Company. Please read and sign
this form as an acknowledgement and acceptance of the terms and conditions of the
payment arrangements.
● The annual premium is $4539. It is subject to change throughout the policy period
based on changes made to the policy.
● Policy Fee is $100. Filing Fee is $75. Policy & Filing fees are earned.
● The initial required payment is $1082.8, which constitutes 20% of the annual premium,
plus Policy and Filing fees.
● Included in the initial payment, is a deposit amount of $526.8, which will be held by
McNabb Insurance Services until the termination of the policy. Adjustment may be
made to the deposit amount throughout the policy period based on changes made to
the policy resulting in additional or return premiums. Unearned portion of the deposit,
if any, will be refunded to you upon termination of the policy.
● You will have eleven monthly payments of $385.56, including an installment fee,
corresponding to 2% of the unpaid premium.
● Payments must be made to McNabb Insurance Services in accordance to invoices
sent to you.
● Payments sent or postmarked fifteen days or less, prior to the cancellation of the
policy due to non-payment of the premium, must be made in a form of a cashier’s
check or a money order, to avoid a 10 day hold.
● There will be a $25.00 fee for each NSF check.
I have read and accept the above referenced conditions.
____________________________________________ __________________________
Insured’s Signature Date
601 S. Glenoaks Blvd., Suite 405. Burbank, CA 91502
Phone: (818) 567-0736 or (800) 694-1717, Fax: (818) 567-0075
www.mcnabbins.com