Insurance Referrals | Vidalia LA | (318) 336-5202

There is no better compliment to us than for you to refer a friend or family member to our agency.

When you refer folks to us, it’s truly a win-win-win.

You receive a $10 gift card
Your friend or family member gets taken care of
We’re able to grow our local business.

Please take a moment to complete the form below, we would be so grateful for your referral.

Master PL Proposal Generator 1/22

Insureds First and Last Name (Include Spouse)*

EX: John and Jane Smith
Property / Garaging Address*
Street Address City State ZIP Code
What Products are Included In This Proposal*
- Home
- Auto
- Personal Umbrella
What Home Carrier Are We Proposing?*
What Auto Carrier Are We Proposing?*
What Personal Umbrella Carrier Are We Proposing?*
Policy Effective Date*

mm/dd/yy - mm/dd/yy

Basic Auto
Vehicle #1*
Year Make Model
Comp Deductible (Always Full Glass)*
Collision Deductible*
Vehicle #2
Year (if no vehicle, use space) Make(if no vehicle, use space) Model(if no vehicle, use space)
Veh 2 Comp Deductible (Always Full Glass)
Veh 2 Collision Deductible
Vehicle #3
Year Make Model
Veh 3 Comp Deductible (Always Full Glass)
Veh 3 Collision Deductible
Vehicle #4
Year Make Model
Veh 4 Comp Deductible (Always Full Glass)
Veh 4 Collision Deductible
Proposed Auto Liability Coverages
Proposed Bodily Injury Per Person / Per Accident*
Proposed Property Damage Liability*
Med Pay Limits*
Proposed UM/UIM*
Proposed UM/UIM Property Damage*

Proposed Additional Coverages (Progressive)
Loss of Use / Rental Reimbursement*
Roadside Assistance*
Loan/Lease/Gap*
Pays the difference between the vehicles Actual Cash Value (ACV) and the amount the insured owes a lender. Applies if the insured's car is deemed a total loss or stolen and the vehicle has comprehensive and collision coverage. This coverage pays up to 25% of the ACV. The lienholder must be listed on the policy and be a financial institution, not an individual. Loan/Lease payoff coverage is not available on stated amount vehicles.
Custom Parts & Equipment*

Provides coverage to vehicle parts or equipment permanently installed by someone other than the original manufacturer. Comprehensive coverage includes $1,000 of CPE. If more than $1,000 but less than $5,000 of coverage is needed, enter the amount in this field. (Including the $1,000 that is included with Comp). For an amount greater than $5,000 the vehicle must be listed as a Stated Amount vehicle on the Product page.
Deductible Savings Bank*
The insured earns $50 toward their deductible for every six-month policy term that they don't have an accident or violation, credited at renewal. Comprehensive and Collision Deductibles must be at least $500. Contents of the bank can be used toward Comprehensive and Collision deductibles in the event of a claim.
Will Customer Be Enrolling in Telematics?*
Signing up today can earn your customer a discount of up to 10%. Then, at renewal, they could earn up to 30% for the remainder of the policy thanks to safe driving habits.
Progressive Semi Annual Premium, Paid Monthly*
Progressive Monthly Premium (EFT)*
Progressive Premium for Policy Period If Paid Semi-Annually*

Master PL Proposal Generator 1/22

Basic Auto

Proposed Auto Liability Coverages

Proposed Additional Coverages (Erie)

Proposed Additional Coverages (Progressive)

Incumbent Auto Policy

Proposed Home Coverages (Erie)

Proposed Home Coverages (Openly)

Incumbent Homeowners Policy

Personal Umbrella