| Personal Information |
| Name |
|
| Street Address |
|
| Address (cont.) |
|
| City |
State: Zip
Code: |
| Home Phone |
Work Phone: |
| Best
Time to Call |
AM
PM |
| Fax |
|
| E-mail
Address |
|
| |
|
Accident-Free - Up to 10% in
certain instances when an accident free record is maintained |
|
Safe Driver - Up to 15% in certain
instances when a violation free driving record is maintained |
|
|
Good Student - Up to 5% if you are
a full time student between the ages of 16 and 24 and meet a certain
grade point or scholastic class ranking requirement |
|
|
Auto Financial
- Up to 5% in certain instances if you own a Nationwide Financial
Services Annuity, Life or Health Policy |
|
|
Affinity or McCafferty Rewards Member
A- Up to 10% if you are a member of a qualifying
organization |
|
|
Farm Bureau - Refer to Farm Bureau
discounts in CA, DE, MD, OH, PA & WV |
|
|
Home and Car - Up to 20% if you
insure both your autos and home with Nationwide |
|
|
Renter and Car - Up to 5% if
you insure both your auto and rented/leased home with Nationwide |
|
|
Advance Quote - Up to 5% discount
customer received a quote (with credit ordered) at least 8 days before
effective date of policy |
|
|
Homeownership - Up to 5% applies
for first year if you own a home (not insured with Nationwide); some
states require a promise t insure with Nationwide within 1 year. |
|
|
Long Term Policy Holder - Up to 5%
if you are insured with Nationwide for at least 3 years. Up to 15% if
you are insured with Nationwide for at least 5 years |
|
|
Passive Occupant Restraint -
20-30% reduction in your medical coverage premiums if your vehicle is
equipped with airbags. |
|
|
Terms with Prior Carrier - Up to
11% depending on the number of years of continuous coverage with select
prior carriers |
|
|
Other
|
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