1. Should I get a traffic violation ticket, I agree to tell my parents and pay for the ticket as well as the difference in the insurance premium for as long as the premium is in effect.

 2. I agree to pay for damages that I incur not covered by insurance.

 3. At no time will I ever drink alcoholic beverages or do drugs and drive at the same time, nor will there be any liquor, beer, or drugs in the car at any time.

 4. I will never transport more passengers than there are seat belts, and will not drive the car until all passengers have buckled up.

5. I will keep the car that I drive clean, inside and out, and be aware of its needs for gas and oil, plus vacuum and wax the car 1st weekend of each month.

6. I will pay for a portion of the car’s upkeep (tires, scheduled maintenance, etc.) as agreed upon by parents and me.

7. I will maintain my grades at a 3.0 average or will pay the increased insurance premium. Good grades and trustworthy conduct are necessary to maintain full driving privileges.

8. I will not smoke nor allow anyone to smoke in the car.

I have read the above agreement and do sign this in accordance with the rules.

Signed,

Parent: ___________________________________________

Child:   ___________________________________________

Siegel Insurance Inc.
1740 Century Circle Suite 8  Atlanta, GA 30345-3028
Phone: (404) 633-6332  Fax: (404) 633-9388
Toll Free: (888) 275-0553