Binder for State Farm Automobile Insurance

Applicant Agent

LISA HALL LAFEVERS, REBECCA J

427538 E 1144 RD 14 E LEE AVE

CHECOTAH, OK 74426-5492 SAPULPA, OK 74066-4214

918-***-****

Vehicle

Year: 2018

Make: HYUNDAI

Model: ELANTRA

Bodystyle: "LTD" 4D SED

VIN: 5NPD84LF1JH264401

Customized: No

The premium shown below must be in compliance with the Company's rules and rates and is subject to revision.

Coverage Applied for: Semi-Annual

Limits Premium

BODILY INJURY AND 50/100/50 * $94.55

PROPERTY DAMAGE LIABILITY

COMPREHENSIVE $500 DEDUCTIBLE $174.87

COLLISION $500 DEDUCTIBLE $140.64

EMERGENCY ROAD SERVICE $4.27

CAR RENTAL/TRAVEL EXPENSES 80%/DAY, $1000 MAX $10.14 Total $424.47

Total of 6 month premium $424.47

Payment received SFPP

* Denotes thousands Balance due SFPP

Binder Effective Date: September 18, 2020

STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois, hereby binds coverage for the insurance applied for as of the requested effective date for a period of 60 days from such date, subject to all the terms and conditions of the applicable policy and endorsements in current use by such Company. Coverage under this binder will terminate

(1) when the Declarations Page of a policy is issued to you or (2) when canceled in accordance with law. By submission of this application, you agree that: (1) you have read this application, (2) your statements on this application are correct, (3) statements made on any other applications on this date for automobile insurance with this company are correct and are made part of this application, (4) you are the sole owner of the described vehicle except as otherwise stated, and (5) the limits and coverages were selected by you. IT IS FURTHER UNDERSTOOD AND AGREED THAT NO INSURANCE IS EFFECTIVE UNDER THIS AGREEMENT (A) UNLESS THE BINDER IS COMPLETED DESIGNATING THE COMPANY ACCEPTING THIS APPLICATION OR (B) UNTIL THE DATE THE POLICY OR BINDER IS ISSUED BY THE COMPANY ACCEPTING THIS APPLICATION.

Consumer reports, including credit and insurance loss history reports, may be ordered in conjunction with this application to help determine your eligibility for insurance and the price you are charged. In addition, consumer reports may be used to determine the price you are charged at renewal. We may also obtain and use a credit-based insurance score developed from information contained in these reports. We may use a third party in connection with the development of your insurance score. A brochure explaining how State Farm uses consumer reports is available upon your request. For additional information, please contact your State Farm agent. ECHO App # 36 -2353-U32 App date and time: 09/18/2020 10:06 AM BINDEROK

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